|
aspirin EC 81 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 71399862702
|
| Hospital Charge Code |
2500075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
aspirin EC 81 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 71399862702
|
| Hospital Charge Code |
2500075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
aspirin EC 81 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 71399101402
|
| Hospital Charge Code |
2500075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
aspirin EC 81 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00536123441
|
| Hospital Charge Code |
2500075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
Assist with procedure - Chest Tube Activity:
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4255022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,191.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,645.00
|
| Rate for Payer: AlohaCare Medicare |
$1,645.00
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Devoted Health Medicare |
$1,809.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,010.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,645.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,125.50
|
| Rate for Payer: Health Management Network Commercial |
$2,796.50
|
| Rate for Payer: Humana Medicare |
$1,645.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,961.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,677.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,645.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,191.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,645.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,645.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,645.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,842.40
|
|
|
Assist with procedure - Chest Tube Activity:
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
4255022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,796.50 |
| Max. Negotiated Rate |
$3,191.30 |
| Rate for Payer: Cash Price |
$2,138.50
|
| Rate for Payer: Health Management Network Commercial |
$2,796.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,961.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,191.30
|
|
|
AST (SGOT) FSI
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
8117852
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
AST (SGOT) FSI
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
8117852
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$50.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.00
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.00
|
| Rate for Payer: University Health Alliance Commercial |
$13.36
|
|
|
atenolol 25 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
2500076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
atenolol 25 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
2500076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
atenolol 25 mg tablet [HHSC]
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
2500076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: AlohaCare Medicaid |
$2.23
|
| Rate for Payer: AlohaCare Medicare |
$2.23
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Devoted Health Medicare |
$2.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network Commercial |
$3.78
|
| Rate for Payer: Humana Medicare |
$2.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.23
|
| Rate for Payer: MDX Hawaii PPO |
$4.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.23
|
| Rate for Payer: University Health Alliance Commercial |
$3.24
|
|
|
atenolol 25 mg tablet [HHSC]
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 51079075920
|
| Hospital Charge Code |
2500076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Health Management Network Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.00
|
| Rate for Payer: MDX Hawaii PPO |
$4.32
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$14,197.50
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$14,197.50 |
| Max. Negotiated Rate |
$14,197.50 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,197.50
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$14,078.99
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$14,078.99 |
| Max. Negotiated Rate |
$14,078.99 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,078.99
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 51079020920
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
OP
|
$4.77
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: AlohaCare Medicaid |
$2.38
|
| Rate for Payer: AlohaCare Medicare |
$2.38
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Devoted Health Medicare |
$2.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.53
|
| Rate for Payer: Health Management Network Commercial |
$4.05
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.38
|
| Rate for Payer: MDX Hawaii PPO |
$4.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.38
|
| Rate for Payer: University Health Alliance Commercial |
$3.48
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
IP
|
$4.77
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Health Management Network Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.29
|
| Rate for Payer: MDX Hawaii PPO |
$4.63
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 51079020920
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
OP
|
$10.90
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: AlohaCare Medicaid |
$5.45
|
| Rate for Payer: AlohaCare Medicare |
$5.45
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Devoted Health Medicare |
$6.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.36
|
| Rate for Payer: Health Management Network Commercial |
$9.27
|
| Rate for Payer: Humana Medicare |
$5.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.45
|
| Rate for Payer: MDX Hawaii PPO |
$10.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.45
|
| Rate for Payer: University Health Alliance Commercial |
$7.95
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
IP
|
$10.90
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Health Management Network Commercial |
$9.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.81
|
| Rate for Payer: MDX Hawaii PPO |
$10.57
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
NDC 00904629304
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Health Management Network Commercial |
$9.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: MDX Hawaii PPO |
$10.48
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
NDC 00904629304
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: AlohaCare Medicaid |
$5.40
|
| Rate for Payer: AlohaCare Medicare |
$5.40
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Devoted Health Medicare |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.26
|
| Rate for Payer: Health Management Network Commercial |
$9.18
|
| Rate for Payer: Humana Medicare |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$10.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.40
|
| Rate for Payer: University Health Alliance Commercial |
$7.87
|
|
|
atropine 1mg/10ml syringe [HHSC]
|
Facility
|
IP
|
$64.55
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
2500081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.87 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$49.13
|
| Rate for Payer: Health Management Network Commercial |
$64.24
|
| Rate for Payer: Health Management Network Commercial |
$52.94
|
| Rate for Payer: Health Management Network Commercial |
$54.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.09
|
| Rate for Payer: MDX Hawaii PPO |
$62.61
|
| Rate for Payer: MDX Hawaii PPO |
$60.41
|
| Rate for Payer: MDX Hawaii PPO |
$73.31
|
|
|
atropine 1mg/10ml syringe [HHSC]
|
Facility
|
OP
|
$64.55
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
2500081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: AlohaCare Medicaid |
$32.27
|
| Rate for Payer: AlohaCare Medicaid |
$37.79
|
| Rate for Payer: AlohaCare Medicaid |
$31.14
|
| Rate for Payer: AlohaCare Medicare |
$37.79
|
| Rate for Payer: AlohaCare Medicare |
$31.14
|
| Rate for Payer: AlohaCare Medicare |
$32.27
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$49.13
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$49.13
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Devoted Health Medicare |
$41.57
|
| Rate for Payer: Devoted Health Medicare |
$35.50
|
| Rate for Payer: Devoted Health Medicare |
$34.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.32
|
| Rate for Payer: Health Management Network Commercial |
$52.94
|
| Rate for Payer: Health Management Network Commercial |
$54.87
|
| Rate for Payer: Health Management Network Commercial |
$64.24
|
| Rate for Payer: Humana Medicare |
$32.27
|
| Rate for Payer: Humana Medicare |
$31.14
|
| Rate for Payer: Humana Medicare |
$37.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.79
|
| Rate for Payer: MDX Hawaii PPO |
$73.31
|
| Rate for Payer: MDX Hawaii PPO |
$60.41
|
| Rate for Payer: MDX Hawaii PPO |
$62.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.27
|
| Rate for Payer: University Health Alliance Commercial |
$55.09
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
| Rate for Payer: University Health Alliance Commercial |
$45.40
|
|
|
Attended E-Stim Charges
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 97032 GP,CQ
|
| Hospital Charge Code |
8111684
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: AlohaCare Medicaid |
$56.00
|
| Rate for Payer: AlohaCare Medicare |
$56.00
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$61.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.40
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$56.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.00
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.00
|
| Rate for Payer: University Health Alliance Commercial |
$62.72
|
|
