|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 10006070033
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904582460
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904582460
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 87701040750
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 80681016900
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 80681016900
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 87701040750
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
cholecalciferol 1000 IntlUnit tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 20555003300
|
| Hospital Charge Code |
2500175
|
|
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
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$38,563.15
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$38,563.15 |
| Max. Negotiated Rate |
$38,563.15 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$38,563.15
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$41,431.10
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$41,431.10 |
| Max. Negotiated Rate |
$41,431.10 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41,431.10
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$26,783.26
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$26,783.26 |
| Max. Negotiated Rate |
$26,783.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26,783.26
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$41,881.43
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$41,881.43 |
| Max. Negotiated Rate |
$41,881.43 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41,881.43
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$50,082.33
|
|
|
Service Code
|
MSDRG 411
|
| Min. Negotiated Rate |
$50,082.33 |
| Max. Negotiated Rate |
$50,082.33 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$50,082.33
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$33,704.24
|
|
|
Service Code
|
MSDRG 413
|
| Min. Negotiated Rate |
$33,704.24 |
| Max. Negotiated Rate |
$33,704.24 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33,704.24
|
|
|
Cholesterol, Body Fluid FSI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
8228852
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
Cholesterol, Body Fluid FSI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
8228852
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.35
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.50
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.25
|
|
|
Cholesterol FSI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
8117882
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.35
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.50
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.25
|
|
|
Cholesterol FSI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
8117882
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
Chromosome Analysis, Whole Blood FSI
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
12351214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$301.12 |
| Rate for Payer: AlohaCare Medicaid |
$84.50
|
| Rate for Payer: AlohaCare Medicare |
$84.50
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Devoted Health Medicare |
$92.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$161.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.49
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Humana Medicare |
$84.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.50
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.50
|
| Rate for Payer: University Health Alliance Commercial |
$301.12
|
|
|
Chromosome Analysis, Whole Blood FSI
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
12351214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$18,487.56
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$18,487.56 |
| Max. Negotiated Rate |
$18,487.56 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,487.56
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$18,487.56
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$18,487.56 |
| Max. Negotiated Rate |
$18,487.56 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,487.56
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$18,487.56
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$18,487.56 |
| Max. Negotiated Rate |
$18,487.56 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,487.56
|
|
|
ciprofloxacin 400 mg/200 mL-D5W premix [HHSC]
|
Facility
|
OP
|
$26.69
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
2500178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$25.89 |
| Rate for Payer: AlohaCare Medicaid |
$13.35
|
| Rate for Payer: AlohaCare Medicaid |
$11.48
|
| Rate for Payer: AlohaCare Medicaid |
$9.31
|
| Rate for Payer: AlohaCare Medicaid |
$14.46
|
| Rate for Payer: AlohaCare Medicaid |
$7.71
|
| Rate for Payer: AlohaCare Medicaid |
$25.27
|
| Rate for Payer: AlohaCare Medicare |
$25.27
|
| Rate for Payer: AlohaCare Medicare |
$13.35
|
| Rate for Payer: AlohaCare Medicare |
$7.71
|
| Rate for Payer: AlohaCare Medicare |
$9.31
|
| Rate for Payer: AlohaCare Medicare |
$11.48
|
| Rate for Payer: AlohaCare Medicare |
$14.46
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Devoted Health Medicare |
$15.90
|
| Rate for Payer: Devoted Health Medicare |
$14.68
|
| Rate for Payer: Devoted Health Medicare |
$8.49
|
| Rate for Payer: Devoted Health Medicare |
$12.63
|
| Rate for Payer: Devoted Health Medicare |
$10.25
|
| Rate for Payer: Devoted Health Medicare |
$27.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.66
|
| Rate for Payer: Health Management Network Commercial |
$24.57
|
| Rate for Payer: Health Management Network Commercial |
$19.52
|
| Rate for Payer: Health Management Network Commercial |
$15.84
|
| Rate for Payer: Health Management Network Commercial |
$13.12
|
| Rate for Payer: Health Management Network Commercial |
$22.69
|
| Rate for Payer: Health Management Network Commercial |
$42.95
|
| Rate for Payer: Humana Medicare |
$9.31
|
| Rate for Payer: Humana Medicare |
$7.71
|
| Rate for Payer: Humana Medicare |
$11.48
|
| Rate for Payer: Humana Medicare |
$14.46
|
| Rate for Payer: Humana Medicare |
$13.35
|
| Rate for Payer: Humana Medicare |
$25.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.31
|
| Rate for Payer: MDX Hawaii PPO |
$14.97
|
| Rate for Payer: MDX Hawaii PPO |
$22.28
|
| Rate for Payer: MDX Hawaii PPO |
$18.07
|
| Rate for Payer: MDX Hawaii PPO |
$25.89
|
| Rate for Payer: MDX Hawaii PPO |
$49.01
|
| Rate for Payer: MDX Hawaii PPO |
$28.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.35
|
| Rate for Payer: University Health Alliance Commercial |
$21.07
|
| Rate for Payer: University Health Alliance Commercial |
$36.83
|
| Rate for Payer: University Health Alliance Commercial |
$19.45
|
| Rate for Payer: University Health Alliance Commercial |
$11.25
|
| Rate for Payer: University Health Alliance Commercial |
$13.58
|
| Rate for Payer: University Health Alliance Commercial |
$16.74
|
|
|
ciprofloxacin 400 mg/200 mL-D5W premix [HHSC]
|
Facility
|
IP
|
$15.43
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
2500178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$14.97 |
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$32.84
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: Health Management Network Commercial |
$13.12
|
| Rate for Payer: Health Management Network Commercial |
$15.84
|
| Rate for Payer: Health Management Network Commercial |
$19.52
|
| Rate for Payer: Health Management Network Commercial |
$22.69
|
| Rate for Payer: Health Management Network Commercial |
$24.57
|
| Rate for Payer: Health Management Network Commercial |
$42.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.67
|
| Rate for Payer: MDX Hawaii PPO |
$22.28
|
| Rate for Payer: MDX Hawaii PPO |
$49.01
|
| Rate for Payer: MDX Hawaii PPO |
$28.04
|
| Rate for Payer: MDX Hawaii PPO |
$25.89
|
| Rate for Payer: MDX Hawaii PPO |
$14.97
|
| Rate for Payer: MDX Hawaii PPO |
$18.07
|
|
