|
ceFAZolin 1 gm vial [HHSC]
|
Facility
|
IP
|
$25.63
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$24.86 |
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Health Management Network Commercial |
$21.79
|
| Rate for Payer: Health Management Network Commercial |
$5.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.32
|
| Rate for Payer: MDX Hawaii PPO |
$6.81
|
| Rate for Payer: MDX Hawaii PPO |
$24.86
|
|
|
ceFAZolin 1 gm vial [HHSC]
|
Facility
|
OP
|
$25.63
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$24.86 |
| Rate for Payer: AlohaCare Medicaid |
$12.81
|
| Rate for Payer: AlohaCare Medicaid |
$3.51
|
| Rate for Payer: AlohaCare Medicare |
$3.51
|
| Rate for Payer: AlohaCare Medicare |
$12.81
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Devoted Health Medicare |
$14.10
|
| Rate for Payer: Devoted Health Medicare |
$3.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.67
|
| Rate for Payer: Health Management Network Commercial |
$5.97
|
| Rate for Payer: Health Management Network Commercial |
$21.79
|
| Rate for Payer: Humana Medicare |
$12.81
|
| Rate for Payer: Humana Medicare |
$3.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.51
|
| Rate for Payer: MDX Hawaii PPO |
$24.86
|
| Rate for Payer: MDX Hawaii PPO |
$6.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.51
|
| Rate for Payer: University Health Alliance Commercial |
$18.68
|
| Rate for Payer: University Health Alliance Commercial |
$5.12
|
|
|
ceFAZolin 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$89.42 |
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Health Management Network Commercial |
$78.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.97
|
| Rate for Payer: MDX Hawaii PPO |
$89.42
|
|
|
ceFAZolin 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$89.42 |
| Rate for Payer: AlohaCare Medicaid |
$46.09
|
| Rate for Payer: AlohaCare Medicare |
$46.09
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Devoted Health Medicare |
$50.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$78.36
|
| Rate for Payer: Humana Medicare |
$46.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.09
|
| Rate for Payer: MDX Hawaii PPO |
$89.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.09
|
| Rate for Payer: University Health Alliance Commercial |
$67.20
|
|
|
cefepime 2000 mg vial [HHSC]
|
Facility
|
OP
|
$186.84
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
2501183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$181.23 |
| Rate for Payer: AlohaCare Medicaid |
$93.42
|
| Rate for Payer: AlohaCare Medicare |
$93.42
|
| Rate for Payer: Cash Price |
$121.45
|
| Rate for Payer: Cash Price |
$121.45
|
| Rate for Payer: Devoted Health Medicare |
$102.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$177.50
|
| Rate for Payer: Health Management Network Commercial |
$158.81
|
| Rate for Payer: Humana Medicare |
$93.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.42
|
| Rate for Payer: MDX Hawaii PPO |
$181.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.42
|
| Rate for Payer: University Health Alliance Commercial |
$136.19
|
|
|
cefepime 2000 mg vial [HHSC]
|
Facility
|
IP
|
$186.84
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
2501183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.81 |
| Max. Negotiated Rate |
$181.23 |
| Rate for Payer: Cash Price |
$121.45
|
| Rate for Payer: Health Management Network Commercial |
$158.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.16
|
| Rate for Payer: MDX Hawaii PPO |
$181.23
|
|
|
cefpodoxime 200 mg tablet [HHSC]
|
Facility
|
IP
|
$50.87
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$49.34 |
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Health Management Network Commercial |
$43.11
|
| Rate for Payer: Health Management Network Commercial |
$43.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.78
|
| Rate for Payer: MDX Hawaii PPO |
$49.34
|
| Rate for Payer: MDX Hawaii PPO |
$49.20
|
|
|
cefpodoxime 200 mg tablet [HHSC]
|
Facility
|
OP
|
$50.87
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$49.34 |
| Rate for Payer: AlohaCare Medicaid |
$25.43
|
| Rate for Payer: AlohaCare Medicaid |
$25.36
|
| Rate for Payer: AlohaCare Medicare |
$25.36
|
| Rate for Payer: AlohaCare Medicare |
$25.43
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Devoted Health Medicare |
$27.90
|
| Rate for Payer: Devoted Health Medicare |
$27.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.18
|
| Rate for Payer: Health Management Network Commercial |
$43.11
|
| Rate for Payer: Health Management Network Commercial |
$43.24
|
| Rate for Payer: Humana Medicare |
$25.36
|
| Rate for Payer: Humana Medicare |
$25.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.36
|
| Rate for Payer: MDX Hawaii PPO |
$49.34
|
| Rate for Payer: MDX Hawaii PPO |
$49.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.43
|
| Rate for Payer: University Health Alliance Commercial |
$36.97
|
| Rate for Payer: University Health Alliance Commercial |
$37.08
|
|
|
cefTRIAXone 1000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$116.86
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$113.35 |
| Rate for Payer: AlohaCare Medicaid |
$58.43
|
| Rate for Payer: AlohaCare Medicare |
$58.43
|
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Devoted Health Medicare |
$64.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.02
|
| Rate for Payer: Health Management Network Commercial |
$99.33
|
| Rate for Payer: Humana Medicare |
$58.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.43
|
| Rate for Payer: MDX Hawaii PPO |
$113.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.43
|
| Rate for Payer: University Health Alliance Commercial |
$85.18
|
|
|
cefTRIAXone 1000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$116.86
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$113.35 |
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Health Management Network Commercial |
$99.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.17
|
| Rate for Payer: MDX Hawaii PPO |
$113.35
|
|
|
cefTRIAXone 1000mg vial [HHSC]
|
Facility
|
IP
|
$10.01
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Health Management Network Commercial |
$13.61
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.41
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: MDX Hawaii PPO |
$15.53
|
|
|
cefTRIAXone 1000mg vial [HHSC]
|
Facility
|
OP
|
$16.01
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: AlohaCare Medicaid |
$8.01
|
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$8.01
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Devoted Health Medicare |
$5.51
|
| Rate for Payer: Devoted Health Medicare |
$8.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.21
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Health Management Network Commercial |
$13.61
|
| Rate for Payer: Humana Medicare |
$5.00
|
| Rate for Payer: Humana Medicare |
$8.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.01
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: MDX Hawaii PPO |
$15.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.00
|
| Rate for Payer: University Health Alliance Commercial |
$7.30
|
| Rate for Payer: University Health Alliance Commercial |
$11.67
|
|
|
cefTRIAXone 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$149.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: AlohaCare Medicaid |
$74.89
|
| Rate for Payer: AlohaCare Medicare |
$74.89
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Devoted Health Medicare |
$82.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.28
|
| Rate for Payer: Health Management Network Commercial |
$127.30
|
| Rate for Payer: Humana Medicare |
$74.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.89
|
| Rate for Payer: MDX Hawaii PPO |
$145.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.89
|
| Rate for Payer: University Health Alliance Commercial |
$109.17
|
|
|
cefTRIAXone 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$149.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Health Management Network Commercial |
$127.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.79
|
| Rate for Payer: MDX Hawaii PPO |
$145.28
|
|
|
cefTRIAXone 500 mg vial [HHSC]
|
Facility
|
OP
|
$6.34
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: AlohaCare Medicaid |
$3.17
|
| Rate for Payer: AlohaCare Medicaid |
$3.83
|
| Rate for Payer: AlohaCare Medicare |
$3.83
|
| Rate for Payer: AlohaCare Medicare |
$3.17
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Devoted Health Medicare |
$3.49
|
| Rate for Payer: Devoted Health Medicare |
$4.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.29
|
| Rate for Payer: Health Management Network Commercial |
$6.52
|
| Rate for Payer: Health Management Network Commercial |
$5.39
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: Humana Medicare |
$3.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.83
|
| Rate for Payer: MDX Hawaii PPO |
$6.15
|
| Rate for Payer: MDX Hawaii PPO |
$7.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.83
|
| Rate for Payer: University Health Alliance Commercial |
$4.62
|
| Rate for Payer: University Health Alliance Commercial |
$5.59
|
|
|
cefTRIAXone 500 mg vial [HHSC]
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Health Management Network Commercial |
$5.39
|
| Rate for Payer: Health Management Network Commercial |
$6.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.90
|
| Rate for Payer: MDX Hawaii PPO |
$7.44
|
| Rate for Payer: MDX Hawaii PPO |
$6.15
|
|
|
CELERO 12 SPRING LOADED CORE BX DEVICE (US)
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
8890533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.50 |
| Max. Negotiated Rate |
$891.43 |
| Rate for Payer: AlohaCare Medicaid |
$459.50
|
| Rate for Payer: AlohaCare Medicare |
$459.50
|
| Rate for Payer: Cash Price |
$597.35
|
| Rate for Payer: Devoted Health Medicare |
$505.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$459.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$873.05
|
| Rate for Payer: Health Management Network Commercial |
$781.15
|
| Rate for Payer: Humana Medicare |
$459.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$827.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$468.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$459.50
|
| Rate for Payer: MDX Hawaii PPO |
$891.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$459.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$459.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$459.50
|
| Rate for Payer: University Health Alliance Commercial |
$669.86
|
|
|
CELERO 12 SPRING LOADED CORE BX DEVICE (US)
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
8890533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.15 |
| Max. Negotiated Rate |
$891.43 |
| Rate for Payer: Cash Price |
$597.35
|
| Rate for Payer: Health Management Network Commercial |
$781.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$827.10
|
| Rate for Payer: MDX Hawaii PPO |
$891.43
|
|
|
Cell Count and Diff Fluid FSI
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
8117878
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$43.00
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Devoted Health Medicare |
$47.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$43.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.00
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.00
|
| Rate for Payer: University Health Alliance Commercial |
$14.24
|
|
|
Cell Count and Diff Fluid FSI
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
8117878
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
Cell Count with Diff CSF FSI
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
8228850
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
Cell Count with Diff CSF FSI
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
8228850
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$43.00
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Devoted Health Medicare |
$47.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$43.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.00
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.00
|
| Rate for Payer: University Health Alliance Commercial |
$14.24
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$23,986.42
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$23,986.42 |
| Max. Negotiated Rate |
$23,986.42 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23,986.42
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$16,141.06
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$16,141.06 |
| Max. Negotiated Rate |
$16,141.06 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16,141.06
|
|
|
cephalexin 250 mg/5 mL 100ml [HHSC]
|
Facility
|
OP
|
$138.32
|
|
|
Service Code
|
NDC 00093417773
|
| Hospital Charge Code |
2500167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.16 |
| Max. Negotiated Rate |
$134.17 |
| Rate for Payer: AlohaCare Medicaid |
$69.16
|
| Rate for Payer: AlohaCare Medicare |
$69.16
|
| Rate for Payer: Cash Price |
$89.91
|
| Rate for Payer: Devoted Health Medicare |
$76.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$117.57
|
| Rate for Payer: Humana Medicare |
$69.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.16
|
| Rate for Payer: MDX Hawaii PPO |
$134.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.16
|
| Rate for Payer: University Health Alliance Commercial |
$100.82
|
|
