|
ENDOCRINE DISORDERS WITH CC
|
Facility
|
IP
|
$19,388.24
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$19,388.24 |
| Max. Negotiated Rate |
$19,388.24 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19,388.24
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
|
IP
|
$19,388.24
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$19,388.24 |
| Max. Negotiated Rate |
$19,388.24 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19,388.24
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,781.02
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$16,781.02 |
| Max. Negotiated Rate |
$16,781.02 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16,781.02
|
|
|
ENDO CUTTER LINEAR, 45MM ARTICULATING (ETHICON)
|
Facility
|
IP
|
$3,121.00
|
|
| Hospital Charge Code |
8274209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,652.85 |
| Max. Negotiated Rate |
$3,027.37 |
| Rate for Payer: Cash Price |
$2,028.65
|
| Rate for Payer: Health Management Network Commercial |
$2,652.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,808.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,027.37
|
|
|
ENDO CUTTER LINEAR, 45MM ARTICULATING (ETHICON)
|
Facility
|
OP
|
$3,121.00
|
|
| Hospital Charge Code |
8274209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,560.50 |
| Max. Negotiated Rate |
$3,027.37 |
| Rate for Payer: AlohaCare Medicaid |
$1,560.50
|
| Rate for Payer: AlohaCare Medicare |
$1,560.50
|
| Rate for Payer: Cash Price |
$2,028.65
|
| Rate for Payer: Devoted Health Medicare |
$1,716.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,560.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,964.95
|
| Rate for Payer: Health Management Network Commercial |
$2,652.85
|
| Rate for Payer: Humana Medicare |
$1,560.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,808.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,591.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,560.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,027.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,560.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,560.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,560.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,274.90
|
|
|
ENDO GIA ROTICULATOR 30/2.0
|
Facility
|
OP
|
$551.00
|
|
| Hospital Charge Code |
8274227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: AlohaCare Medicaid |
$275.50
|
| Rate for Payer: AlohaCare Medicare |
$275.50
|
| Rate for Payer: Cash Price |
$358.15
|
| Rate for Payer: Devoted Health Medicare |
$303.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$523.45
|
| Rate for Payer: Health Management Network Commercial |
$468.35
|
| Rate for Payer: Humana Medicare |
$275.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$495.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$281.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.50
|
| Rate for Payer: MDX Hawaii PPO |
$534.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$275.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.50
|
| Rate for Payer: University Health Alliance Commercial |
$401.62
|
|
|
ENDO GIA ROTICULATOR 30/2.0
|
Facility
|
IP
|
$551.00
|
|
| Hospital Charge Code |
8274227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.35 |
| Max. Negotiated Rate |
$534.47 |
| Rate for Payer: Cash Price |
$358.15
|
| Rate for Payer: Health Management Network Commercial |
$468.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$495.90
|
| Rate for Payer: MDX Hawaii PPO |
$534.47
|
|
|
ENDO GIA ROTICULATOR 45/2.0
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
8274228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.50 |
| Max. Negotiated Rate |
$730.41 |
| Rate for Payer: AlohaCare Medicaid |
$376.50
|
| Rate for Payer: AlohaCare Medicare |
$376.50
|
| Rate for Payer: Cash Price |
$489.45
|
| Rate for Payer: Devoted Health Medicare |
$414.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$715.35
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Humana Medicare |
$376.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$384.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.50
|
| Rate for Payer: MDX Hawaii PPO |
$730.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$376.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.50
|
| Rate for Payer: University Health Alliance Commercial |
$548.86
|
|
|
ENDO GIA ROTICULATOR 45/2.0
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
8274228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$640.05 |
| Max. Negotiated Rate |
$730.41 |
| Rate for Payer: Cash Price |
$489.45
|
| Rate for Payer: Health Management Network Commercial |
$640.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$677.70
|
| Rate for Payer: MDX Hawaii PPO |
$730.41
|
|
|
ENDO GIA ROTICULATOR 45/2.5 VASCULAR
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
8274229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$583.94 |
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Health Management Network Commercial |
$511.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.80
|
| Rate for Payer: MDX Hawaii PPO |
$583.94
|
|
|
ENDO GIA ROTICULATOR 45/2.5 VASCULAR
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
8274229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$583.94 |
| Rate for Payer: AlohaCare Medicaid |
$301.00
|
| Rate for Payer: AlohaCare Medicare |
$301.00
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Devoted Health Medicare |
$331.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$301.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.90
|
| Rate for Payer: Health Management Network Commercial |
$511.70
|
| Rate for Payer: Humana Medicare |
$301.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$307.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.00
|
| Rate for Payer: MDX Hawaii PPO |
$583.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$301.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$301.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$301.00
|
| Rate for Payer: University Health Alliance Commercial |
$438.80
|
|
|
ENDO GIA ROTICULATOR 45/3.5
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
8274230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$583.94 |
| Rate for Payer: AlohaCare Medicaid |
$301.00
|
| Rate for Payer: AlohaCare Medicare |
$301.00
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Devoted Health Medicare |
$331.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$301.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.90
|
| Rate for Payer: Health Management Network Commercial |
$511.70
|
| Rate for Payer: Humana Medicare |
$301.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$307.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.00
|
| Rate for Payer: MDX Hawaii PPO |
$583.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$301.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$301.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$301.00
|
| Rate for Payer: University Health Alliance Commercial |
$438.80
|
|
|
ENDO GIA ROTICULATOR 45/3.5
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
8274230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$583.94 |
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Health Management Network Commercial |
$511.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.80
|
| Rate for Payer: MDX Hawaii PPO |
$583.94
|
|
|
ENDO GIA UNIVERSAL 12MM HANDLE
|
Facility
|
OP
|
$479.00
|
|
| Hospital Charge Code |
8274210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.50 |
| Max. Negotiated Rate |
$464.63 |
| Rate for Payer: AlohaCare Medicaid |
$239.50
|
| Rate for Payer: AlohaCare Medicare |
$239.50
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Devoted Health Medicare |
$263.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$455.05
|
| Rate for Payer: Health Management Network Commercial |
$407.15
|
| Rate for Payer: Humana Medicare |
$239.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.50
|
| Rate for Payer: MDX Hawaii PPO |
$464.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.50
|
| Rate for Payer: University Health Alliance Commercial |
$349.14
|
|
|
ENDO GIA UNIVERSAL 12MM HANDLE
|
Facility
|
IP
|
$479.00
|
|
| Hospital Charge Code |
8274210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.15 |
| Max. Negotiated Rate |
$464.63 |
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Health Management Network Commercial |
$407.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.10
|
| Rate for Payer: MDX Hawaii PPO |
$464.63
|
|
|
ENDO ROTH NET
|
Facility
|
OP
|
$394.00
|
|
| Hospital Charge Code |
8274215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.00 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: AlohaCare Medicaid |
$197.00
|
| Rate for Payer: AlohaCare Medicare |
$197.00
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Devoted Health Medicare |
$216.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$374.30
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Humana Medicare |
$197.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.00
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$197.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.00
|
| Rate for Payer: University Health Alliance Commercial |
$287.19
|
|
|
ENDO ROTH NET
|
Facility
|
IP
|
$394.00
|
|
| Hospital Charge Code |
8274215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.90 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
|
|
ENDO:TALON GRASPING DEVICE
|
Facility
|
OP
|
$590.00
|
|
| Hospital Charge Code |
12818165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$572.30 |
| Rate for Payer: AlohaCare Medicaid |
$295.00
|
| Rate for Payer: AlohaCare Medicare |
$295.00
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Devoted Health Medicare |
$324.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.50
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Humana Medicare |
$295.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.00
|
| Rate for Payer: MDX Hawaii PPO |
$572.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$295.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.00
|
| Rate for Payer: University Health Alliance Commercial |
$430.05
|
|
|
ENDO:TALON GRASPING DEVICE
|
Facility
|
IP
|
$590.00
|
|
| Hospital Charge Code |
12818165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$572.30 |
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.00
|
| Rate for Payer: MDX Hawaii PPO |
$572.30
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$96,040.50
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$96,040.50 |
| Max. Negotiated Rate |
$96,040.50 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$96,040.50
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$92,366.69
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$92,366.69 |
| Max. Negotiated Rate |
$92,366.69 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92,366.69
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$80,444.59
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$80,444.59 |
| Max. Negotiated Rate |
$80,444.59 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80,444.59
|
|
|
enoxaparin 100 mg/1mL syringe [HHSC]
|
Facility
|
IP
|
$114.86
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$111.41 |
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Health Management Network Commercial |
$97.63
|
| Rate for Payer: Health Management Network Commercial |
$100.19
|
| Rate for Payer: Health Management Network Commercial |
$379.23
|
| Rate for Payer: Health Management Network Commercial |
$55.16
|
| Rate for Payer: Health Management Network Commercial |
$58.74
|
| Rate for Payer: Health Management Network Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.54
|
| Rate for Payer: MDX Hawaii PPO |
$432.77
|
| Rate for Payer: MDX Hawaii PPO |
$93.62
|
| Rate for Payer: MDX Hawaii PPO |
$67.04
|
| Rate for Payer: MDX Hawaii PPO |
$62.95
|
| Rate for Payer: MDX Hawaii PPO |
$111.41
|
| Rate for Payer: MDX Hawaii PPO |
$114.33
|
|
|
enoxaparin 100 mg/1mL syringe [HHSC]
|
Facility
|
OP
|
$64.90
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$62.95 |
| Rate for Payer: AlohaCare Medicaid |
$32.45
|
| Rate for Payer: AlohaCare Medicaid |
$223.07
|
| Rate for Payer: AlohaCare Medicaid |
$58.94
|
| Rate for Payer: AlohaCare Medicaid |
$34.55
|
| Rate for Payer: AlohaCare Medicaid |
$57.43
|
| Rate for Payer: AlohaCare Medicaid |
$48.26
|
| Rate for Payer: AlohaCare Medicare |
$48.26
|
| Rate for Payer: AlohaCare Medicare |
$32.45
|
| Rate for Payer: AlohaCare Medicare |
$57.43
|
| Rate for Payer: AlohaCare Medicare |
$58.94
|
| Rate for Payer: AlohaCare Medicare |
$223.07
|
| Rate for Payer: AlohaCare Medicare |
$34.55
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Devoted Health Medicare |
$38.01
|
| Rate for Payer: Devoted Health Medicare |
$35.70
|
| Rate for Payer: Devoted Health Medicare |
$63.17
|
| Rate for Payer: Devoted Health Medicare |
$245.38
|
| Rate for Payer: Devoted Health Medicare |
$64.83
|
| Rate for Payer: Devoted Health Medicare |
$53.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.12
|
| Rate for Payer: Health Management Network Commercial |
$58.74
|
| Rate for Payer: Health Management Network Commercial |
$379.23
|
| Rate for Payer: Health Management Network Commercial |
$100.19
|
| Rate for Payer: Health Management Network Commercial |
$97.63
|
| Rate for Payer: Health Management Network Commercial |
$55.16
|
| Rate for Payer: Health Management Network Commercial |
$82.04
|
| Rate for Payer: Humana Medicare |
$58.94
|
| Rate for Payer: Humana Medicare |
$57.43
|
| Rate for Payer: Humana Medicare |
$223.07
|
| Rate for Payer: Humana Medicare |
$34.55
|
| Rate for Payer: Humana Medicare |
$32.45
|
| Rate for Payer: Humana Medicare |
$48.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$223.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.94
|
| Rate for Payer: MDX Hawaii PPO |
$111.41
|
| Rate for Payer: MDX Hawaii PPO |
$432.77
|
| Rate for Payer: MDX Hawaii PPO |
$114.33
|
| Rate for Payer: MDX Hawaii PPO |
$62.95
|
| Rate for Payer: MDX Hawaii PPO |
$93.62
|
| Rate for Payer: MDX Hawaii PPO |
$67.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.45
|
| Rate for Payer: University Health Alliance Commercial |
$50.37
|
| Rate for Payer: University Health Alliance Commercial |
$70.35
|
| Rate for Payer: University Health Alliance Commercial |
$47.31
|
| Rate for Payer: University Health Alliance Commercial |
$83.72
|
| Rate for Payer: University Health Alliance Commercial |
$85.92
|
| Rate for Payer: University Health Alliance Commercial |
$325.20
|
|
|
enoxaparin 30 mg/0.3 ml syringe [HHSC]
|
Facility
|
OP
|
$20.08
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: AlohaCare Medicaid |
$10.04
|
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicaid |
$10.04
|
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$10.04
|
| Rate for Payer: AlohaCare Medicare |
$10.04
|
| Rate for Payer: AlohaCare Medicare |
$22.29
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Devoted Health Medicare |
$11.04
|
| Rate for Payer: Devoted Health Medicare |
$11.04
|
| Rate for Payer: Devoted Health Medicare |
$10.16
|
| Rate for Payer: Devoted Health Medicare |
$24.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.34
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Health Management Network Commercial |
$17.06
|
| Rate for Payer: Health Management Network Commercial |
$15.71
|
| Rate for Payer: Health Management Network Commercial |
$17.07
|
| Rate for Payer: Humana Medicare |
$10.04
|
| Rate for Payer: Humana Medicare |
$9.24
|
| Rate for Payer: Humana Medicare |
$10.04
|
| Rate for Payer: Humana Medicare |
$22.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.24
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
| Rate for Payer: MDX Hawaii PPO |
$19.48
|
| Rate for Payer: MDX Hawaii PPO |
$19.47
|
| Rate for Payer: MDX Hawaii PPO |
$17.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.24
|
| Rate for Payer: University Health Alliance Commercial |
$32.49
|
| Rate for Payer: University Health Alliance Commercial |
$14.64
|
| Rate for Payer: University Health Alliance Commercial |
$13.47
|
| Rate for Payer: University Health Alliance Commercial |
$14.63
|
|
