|
enoxaparin 30 mg/0.3 ml syringe [HHSC]
|
Facility
|
IP
|
$20.07
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$19.47 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Health Management Network Commercial |
$15.71
|
| Rate for Payer: Health Management Network Commercial |
$17.06
|
| Rate for Payer: Health Management Network Commercial |
$17.07
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.06
|
| Rate for Payer: MDX Hawaii PPO |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$19.48
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
| Rate for Payer: MDX Hawaii PPO |
$19.47
|
|
|
enoxaparin 40 mg/0.4 ml syringe [HHSC]
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: AlohaCare Medicaid |
$9.38
|
| Rate for Payer: AlohaCare Medicaid |
$12.28
|
| Rate for Payer: AlohaCare Medicaid |
$13.38
|
| Rate for Payer: AlohaCare Medicaid |
$22.37
|
| Rate for Payer: AlohaCare Medicaid |
$28.04
|
| Rate for Payer: AlohaCare Medicaid |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$13.38
|
| Rate for Payer: AlohaCare Medicare |
$28.04
|
| Rate for Payer: AlohaCare Medicare |
$12.28
|
| Rate for Payer: AlohaCare Medicare |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$9.38
|
| Rate for Payer: AlohaCare Medicare |
$22.37
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Devoted Health Medicare |
$13.50
|
| Rate for Payer: Devoted Health Medicare |
$30.84
|
| Rate for Payer: Devoted Health Medicare |
$24.61
|
| Rate for Payer: Devoted Health Medicare |
$14.71
|
| Rate for Payer: Devoted Health Medicare |
$10.31
|
| Rate for Payer: Devoted Health Medicare |
$25.41
|
| 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 |
$22.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.04
|
| 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 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 |
$17.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.32
|
| Rate for Payer: Health Management Network Commercial |
$47.67
|
| Rate for Payer: Health Management Network Commercial |
$20.87
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$15.94
|
| Rate for Payer: Health Management Network Commercial |
$22.74
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Humana Medicare |
$28.04
|
| Rate for Payer: Humana Medicare |
$9.38
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Humana Medicare |
$13.38
|
| Rate for Payer: Humana Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.04
|
| Rate for Payer: MDX Hawaii PPO |
$54.40
|
| Rate for Payer: MDX Hawaii PPO |
$18.19
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$23.81
|
| Rate for Payer: MDX Hawaii PPO |
$25.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.37
|
| Rate for Payer: University Health Alliance Commercial |
$13.67
|
| Rate for Payer: University Health Alliance Commercial |
$32.61
|
| Rate for Payer: University Health Alliance Commercial |
$33.68
|
| Rate for Payer: University Health Alliance Commercial |
$40.88
|
| Rate for Payer: University Health Alliance Commercial |
$19.50
|
| Rate for Payer: University Health Alliance Commercial |
$17.89
|
|
|
enoxaparin 40 mg/0.4 ml syringe [HHSC]
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Health Management Network Commercial |
$15.94
|
| Rate for Payer: Health Management Network Commercial |
$20.87
|
| Rate for Payer: Health Management Network Commercial |
$22.74
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$47.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.07
|
| Rate for Payer: MDX Hawaii PPO |
$25.95
|
| Rate for Payer: MDX Hawaii PPO |
$54.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$18.19
|
| Rate for Payer: MDX Hawaii PPO |
$23.81
|
|
|
Enterovirus PCR, CSF FSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
8228866
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: AlohaCare Medicaid |
$196.00
|
| Rate for Payer: AlohaCare Medicare |
$196.00
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Devoted Health Medicare |
$215.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$196.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Humana Medicare |
$196.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.00
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$196.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
Enterovirus PCR, CSF FSI
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
8228866
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
|
|
Eosinophils Urine FSI
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
8404551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$33.50
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$36.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$33.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.50
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
Eosinophils Urine FSI
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
8404551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
EPINEPHrine 1mg/10ml syringe [HHSC]
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
2500294
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: AlohaCare Medicaid |
$22.37
|
| Rate for Payer: AlohaCare Medicaid |
$40.42
|
| Rate for Payer: AlohaCare Medicaid |
$20.14
|
| Rate for Payer: AlohaCare Medicaid |
$15.21
|
| Rate for Payer: AlohaCare Medicare |
$15.21
|
| Rate for Payer: AlohaCare Medicare |
$20.14
|
| Rate for Payer: AlohaCare Medicare |
$22.37
|
| Rate for Payer: AlohaCare Medicare |
$40.42
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$52.55
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cash Price |
$52.55
|
| Rate for Payer: Devoted Health Medicare |
$22.16
|
| Rate for Payer: Devoted Health Medicare |
$24.61
|
| Rate for Payer: Devoted Health Medicare |
$16.73
|
| Rate for Payer: Devoted Health Medicare |
$44.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.81
|
| Rate for Payer: Health Management Network Commercial |
$68.72
|
| Rate for Payer: Health Management Network Commercial |
$34.25
|
| Rate for Payer: Health Management Network Commercial |
$25.86
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Humana Medicare |
$20.14
|
| Rate for Payer: Humana Medicare |
$15.21
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Humana Medicare |
$40.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.21
|
| Rate for Payer: MDX Hawaii PPO |
$78.42
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$39.08
|
| Rate for Payer: MDX Hawaii PPO |
$29.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.21
|
| Rate for Payer: University Health Alliance Commercial |
$58.93
|
| Rate for Payer: University Health Alliance Commercial |
$32.61
|
| Rate for Payer: University Health Alliance Commercial |
$22.17
|
| Rate for Payer: University Health Alliance Commercial |
$29.37
|
|
|
EPINEPHrine 1mg/10ml syringe [HHSC]
|
Facility
|
IP
|
$40.29
|
|
|
Service Code
|
HCPCS J0168
|
| Hospital Charge Code |
2500294
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$39.08 |
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cash Price |
$19.77
|
| Rate for Payer: Cash Price |
$52.55
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Health Management Network Commercial |
$25.86
|
| Rate for Payer: Health Management Network Commercial |
$34.25
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$68.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.26
|
| Rate for Payer: MDX Hawaii PPO |
$29.51
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$78.42
|
| Rate for Payer: MDX Hawaii PPO |
$39.08
|
|
|
EPINEPHrine 1 mg/mL PF soln [HHSC]
|
Facility
|
OP
|
$91.30
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
2500296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$88.56 |
| Rate for Payer: AlohaCare Medicaid |
$45.65
|
| Rate for Payer: AlohaCare Medicare |
$45.65
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Devoted Health Medicare |
$50.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.73
|
| Rate for Payer: Health Management Network Commercial |
$77.61
|
| Rate for Payer: Humana Medicare |
$45.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.65
|
| Rate for Payer: MDX Hawaii PPO |
$88.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.65
|
| Rate for Payer: University Health Alliance Commercial |
$66.55
|
|
|
EPINEPHrine 1 mg/mL PF soln [HHSC]
|
Facility
|
IP
|
$91.30
|
|
|
Service Code
|
HCPCS J0166
|
| Hospital Charge Code |
2500296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.61 |
| Max. Negotiated Rate |
$88.56 |
| Rate for Payer: Cash Price |
$59.34
|
| Rate for Payer: Health Management Network Commercial |
$77.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.17
|
| Rate for Payer: MDX Hawaii PPO |
$88.56
|
|
|
EPINEPHrine 4 mg/250 mL-NS premix [HHSC]
|
Facility
|
IP
|
$467.72
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
2501189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$397.56 |
| Max. Negotiated Rate |
$453.69 |
| Rate for Payer: Cash Price |
$304.02
|
| Rate for Payer: Health Management Network Commercial |
$397.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$420.95
|
| Rate for Payer: MDX Hawaii PPO |
$453.69
|
|
|
EPINEPHrine 4 mg/250 mL-NS premix [HHSC]
|
Facility
|
OP
|
$467.72
|
|
|
Service Code
|
HCPCS J0169
|
| Hospital Charge Code |
2501189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$453.69 |
| Rate for Payer: AlohaCare Medicaid |
$233.86
|
| Rate for Payer: AlohaCare Medicare |
$233.86
|
| Rate for Payer: Cash Price |
$304.02
|
| Rate for Payer: Cash Price |
$304.02
|
| Rate for Payer: Devoted Health Medicare |
$257.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$233.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$444.33
|
| Rate for Payer: Health Management Network Commercial |
$397.56
|
| Rate for Payer: Humana Medicare |
$233.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$420.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.86
|
| Rate for Payer: MDX Hawaii PPO |
$453.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$233.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$233.86
|
| Rate for Payer: University Health Alliance Commercial |
$340.92
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$10,405.18
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$10,405.18 |
| Max. Negotiated Rate |
$10,405.18 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,405.18
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$10,405.18
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$10,405.18 |
| Max. Negotiated Rate |
$10,405.18 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,405.18
|
|
|
eptifibatide 20mg/10 mL vial [HHSC]
|
Facility
|
IP
|
$168.63
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
2500303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$143.34 |
| Max. Negotiated Rate |
$163.57 |
| Rate for Payer: Cash Price |
$109.61
|
| Rate for Payer: Cash Price |
$401.54
|
| Rate for Payer: Cash Price |
$462.96
|
| Rate for Payer: Cash Price |
$412.36
|
| Rate for Payer: Cash Price |
$302.39
|
| Rate for Payer: Health Management Network Commercial |
$605.41
|
| Rate for Payer: Health Management Network Commercial |
$395.43
|
| Rate for Payer: Health Management Network Commercial |
$525.09
|
| Rate for Payer: Health Management Network Commercial |
$539.24
|
| Rate for Payer: Health Management Network Commercial |
$143.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$418.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$641.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$555.98
|
| Rate for Payer: MDX Hawaii PPO |
$690.88
|
| Rate for Payer: MDX Hawaii PPO |
$599.22
|
| Rate for Payer: MDX Hawaii PPO |
$163.57
|
| Rate for Payer: MDX Hawaii PPO |
$615.37
|
| Rate for Payer: MDX Hawaii PPO |
$451.25
|
|
|
eptifibatide 20mg/10 mL vial [HHSC]
|
Facility
|
OP
|
$617.75
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
2500303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$599.22 |
| Rate for Payer: AlohaCare Medicaid |
$308.88
|
| Rate for Payer: AlohaCare Medicaid |
$317.20
|
| Rate for Payer: AlohaCare Medicaid |
$84.31
|
| Rate for Payer: AlohaCare Medicaid |
$232.60
|
| Rate for Payer: AlohaCare Medicaid |
$356.12
|
| Rate for Payer: AlohaCare Medicare |
$356.12
|
| Rate for Payer: AlohaCare Medicare |
$232.60
|
| Rate for Payer: AlohaCare Medicare |
$84.31
|
| Rate for Payer: AlohaCare Medicare |
$308.88
|
| Rate for Payer: AlohaCare Medicare |
$317.20
|
| Rate for Payer: Cash Price |
$401.54
|
| Rate for Payer: Cash Price |
$302.39
|
| Rate for Payer: Cash Price |
$412.36
|
| Rate for Payer: Cash Price |
$401.54
|
| Rate for Payer: Cash Price |
$462.96
|
| Rate for Payer: Cash Price |
$302.39
|
| Rate for Payer: Cash Price |
$462.96
|
| Rate for Payer: Cash Price |
$412.36
|
| Rate for Payer: Cash Price |
$109.61
|
| Rate for Payer: Cash Price |
$109.61
|
| Rate for Payer: Devoted Health Medicare |
$348.92
|
| Rate for Payer: Devoted Health Medicare |
$92.75
|
| Rate for Payer: Devoted Health Medicare |
$339.76
|
| Rate for Payer: Devoted Health Medicare |
$255.87
|
| Rate for Payer: Devoted Health Medicare |
$391.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$356.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$317.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$586.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$676.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$441.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$602.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$160.20
|
| Rate for Payer: Health Management Network Commercial |
$143.34
|
| Rate for Payer: Health Management Network Commercial |
$605.41
|
| Rate for Payer: Health Management Network Commercial |
$525.09
|
| Rate for Payer: Health Management Network Commercial |
$539.24
|
| Rate for Payer: Health Management Network Commercial |
$395.43
|
| Rate for Payer: Humana Medicare |
$308.88
|
| Rate for Payer: Humana Medicare |
$84.31
|
| Rate for Payer: Humana Medicare |
$232.60
|
| Rate for Payer: Humana Medicare |
$317.20
|
| Rate for Payer: Humana Medicare |
$356.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$570.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$641.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$555.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$418.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$315.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$363.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$317.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$308.88
|
| Rate for Payer: MDX Hawaii PPO |
$451.25
|
| Rate for Payer: MDX Hawaii PPO |
$599.22
|
| Rate for Payer: MDX Hawaii PPO |
$615.37
|
| Rate for Payer: MDX Hawaii PPO |
$163.57
|
| Rate for Payer: MDX Hawaii PPO |
$690.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$317.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$356.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$308.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$356.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$317.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$427.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$380.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$279.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$101.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$356.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$317.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.88
|
| Rate for Payer: University Health Alliance Commercial |
$122.91
|
| Rate for Payer: University Health Alliance Commercial |
$450.28
|
| Rate for Payer: University Health Alliance Commercial |
$339.09
|
| Rate for Payer: University Health Alliance Commercial |
$462.41
|
| Rate for Payer: University Health Alliance Commercial |
$519.16
|
|
|
eptifibatide 75 mg/100mL RTU vial [HHSC]
|
Facility
|
OP
|
$492.80
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
2500302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$478.02 |
| Rate for Payer: AlohaCare Medicaid |
$246.40
|
| Rate for Payer: AlohaCare Medicaid |
$434.50
|
| Rate for Payer: AlohaCare Medicaid |
$610.86
|
| Rate for Payer: AlohaCare Medicaid |
$709.80
|
| Rate for Payer: AlohaCare Medicaid |
$767.20
|
| Rate for Payer: AlohaCare Medicaid |
$857.73
|
| Rate for Payer: AlohaCare Medicaid |
$735.01
|
| Rate for Payer: AlohaCare Medicare |
$735.01
|
| Rate for Payer: AlohaCare Medicare |
$246.40
|
| Rate for Payer: AlohaCare Medicare |
$857.73
|
| Rate for Payer: AlohaCare Medicare |
$709.80
|
| Rate for Payer: AlohaCare Medicare |
$434.50
|
| Rate for Payer: AlohaCare Medicare |
$610.86
|
| Rate for Payer: AlohaCare Medicare |
$767.20
|
| Rate for Payer: Cash Price |
$922.75
|
| Rate for Payer: Cash Price |
$997.36
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Cash Price |
$922.75
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Cash Price |
$320.32
|
| Rate for Payer: Cash Price |
$320.32
|
| Rate for Payer: Cash Price |
$1,115.04
|
| Rate for Payer: Cash Price |
$955.51
|
| Rate for Payer: Cash Price |
$955.51
|
| Rate for Payer: Cash Price |
$1,115.04
|
| Rate for Payer: Cash Price |
$997.36
|
| Rate for Payer: Devoted Health Medicare |
$271.04
|
| Rate for Payer: Devoted Health Medicare |
$943.50
|
| Rate for Payer: Devoted Health Medicare |
$843.92
|
| Rate for Payer: Devoted Health Medicare |
$808.51
|
| Rate for Payer: Devoted Health Medicare |
$477.95
|
| Rate for Payer: Devoted Health Medicare |
$671.94
|
| Rate for Payer: Devoted Health Medicare |
$780.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$709.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$857.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$767.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$735.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$610.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,629.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$825.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,457.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,348.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,396.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,160.62
|
| Rate for Payer: Health Management Network Commercial |
$1,206.67
|
| Rate for Payer: Health Management Network Commercial |
$1,038.45
|
| Rate for Payer: Health Management Network Commercial |
$1,249.52
|
| Rate for Payer: Health Management Network Commercial |
$1,304.24
|
| Rate for Payer: Health Management Network Commercial |
$1,458.13
|
| Rate for Payer: Health Management Network Commercial |
$418.88
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Humana Medicare |
$246.40
|
| Rate for Payer: Humana Medicare |
$767.20
|
| Rate for Payer: Humana Medicare |
$434.50
|
| Rate for Payer: Humana Medicare |
$735.01
|
| Rate for Payer: Humana Medicare |
$610.86
|
| Rate for Payer: Humana Medicare |
$709.80
|
| Rate for Payer: Humana Medicare |
$857.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,323.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,380.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,543.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,099.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,277.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$749.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$874.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$782.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$623.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$443.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$724.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$767.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$709.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$735.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$857.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$610.86
|
| Rate for Payer: MDX Hawaii PPO |
$1,663.99
|
| Rate for Payer: MDX Hawaii PPO |
$1,488.37
|
| Rate for Payer: MDX Hawaii PPO |
$478.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,377.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,185.06
|
| Rate for Payer: MDX Hawaii PPO |
$1,425.92
|
| Rate for Payer: MDX Hawaii PPO |
$842.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$857.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$767.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$735.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$610.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$709.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$246.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$709.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$246.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$857.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$767.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$735.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$610.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$295.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$882.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$733.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$851.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$920.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,029.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$857.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$610.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$709.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$767.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$735.01
|
| Rate for Payer: University Health Alliance Commercial |
$1,071.50
|
| Rate for Payer: University Health Alliance Commercial |
$633.41
|
| Rate for Payer: University Health Alliance Commercial |
$1,034.75
|
| Rate for Payer: University Health Alliance Commercial |
$1,250.39
|
| Rate for Payer: University Health Alliance Commercial |
$890.50
|
| Rate for Payer: University Health Alliance Commercial |
$359.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,118.42
|
|
|
eptifibatide 75 mg/100mL RTU vial [HHSC]
|
Facility
|
IP
|
$1,221.71
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
2500302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,038.45 |
| Max. Negotiated Rate |
$1,185.06 |
| Rate for Payer: Kaiser Permanente Commercial |
$1,323.02
|
| Rate for Payer: Cash Price |
$794.11
|
| Rate for Payer: Cash Price |
$922.75
|
| Rate for Payer: Cash Price |
$955.51
|
| Rate for Payer: Cash Price |
$997.36
|
| Rate for Payer: Cash Price |
$1,115.04
|
| Rate for Payer: Cash Price |
$320.32
|
| Rate for Payer: Cash Price |
$564.85
|
| Rate for Payer: Health Management Network Commercial |
$418.88
|
| Rate for Payer: Health Management Network Commercial |
$1,038.45
|
| Rate for Payer: Health Management Network Commercial |
$738.65
|
| Rate for Payer: Health Management Network Commercial |
$1,304.24
|
| Rate for Payer: Health Management Network Commercial |
$1,458.13
|
| Rate for Payer: Health Management Network Commercial |
$1,249.52
|
| Rate for Payer: Health Management Network Commercial |
$1,206.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,380.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,277.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,099.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,543.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,663.99
|
| Rate for Payer: MDX Hawaii PPO |
$842.93
|
| Rate for Payer: MDX Hawaii PPO |
$1,425.92
|
| Rate for Payer: MDX Hawaii PPO |
$1,488.37
|
| Rate for Payer: MDX Hawaii PPO |
$1,377.02
|
| Rate for Payer: MDX Hawaii PPO |
$478.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,185.06
|
|
|
ER 2ND PROCEDURE TechFee
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
8265129
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$280.00
|
| Rate for Payer: AlohaCare Medicare |
$280.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Devoted Health Medicare |
$308.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$280.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$532.00
|
| Rate for Payer: Health Management Network Commercial |
$476.00
|
| Rate for Payer: Humana Medicare |
$280.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$504.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$280.00
|
| Rate for Payer: MDX Hawaii PPO |
$543.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$280.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$280.00
|
| Rate for Payer: University Health Alliance Commercial |
$408.18
|
|
|
ER 2ND PROCEDURE TechFee
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
8265129
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$543.20 |
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Health Management Network Commercial |
$476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$504.00
|
| Rate for Payer: MDX Hawaii PPO |
$543.20
|
|
|
ER FACILITY PROCEDURE, LEVEL 2
|
Facility
|
OP
|
$925.00
|
|
| Hospital Charge Code |
8301084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$462.50
|
| Rate for Payer: AlohaCare Medicare |
$462.50
|
| Rate for Payer: Cash Price |
$601.25
|
| Rate for Payer: Cash Price |
$601.25
|
| Rate for Payer: Devoted Health Medicare |
$508.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$462.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$878.75
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Humana Medicare |
$462.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$832.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$462.50
|
| Rate for Payer: MDX Hawaii PPO |
$897.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$462.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$462.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$462.50
|
| Rate for Payer: University Health Alliance Commercial |
$674.23
|
|
|
ER FACILITY PROCEDURE, LEVEL 2
|
Facility
|
IP
|
$925.00
|
|
| Hospital Charge Code |
8301084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$786.25 |
| Max. Negotiated Rate |
$897.25 |
| Rate for Payer: Cash Price |
$601.25
|
| Rate for Payer: Health Management Network Commercial |
$786.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$832.50
|
| Rate for Payer: MDX Hawaii PPO |
$897.25
|
|
|
ER FACILITY PROCEDURE, LEVEL 3
|
Facility
|
IP
|
$1,880.00
|
|
| Hospital Charge Code |
8301085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,598.00 |
| Max. Negotiated Rate |
$1,823.60 |
| Rate for Payer: Cash Price |
$1,222.00
|
| Rate for Payer: Health Management Network Commercial |
$1,598.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,692.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,823.60
|
|
|
ER FACILITY PROCEDURE, LEVEL 3
|
Facility
|
OP
|
$1,880.00
|
|
| Hospital Charge Code |
8301085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,823.60 |
| Rate for Payer: AlohaCare Medicaid |
$940.00
|
| Rate for Payer: AlohaCare Medicare |
$940.00
|
| Rate for Payer: Cash Price |
$1,222.00
|
| Rate for Payer: Cash Price |
$1,222.00
|
| Rate for Payer: Devoted Health Medicare |
$1,034.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$940.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,786.00
|
| Rate for Payer: Health Management Network Commercial |
$1,598.00
|
| Rate for Payer: Humana Medicare |
$940.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,692.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$940.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,823.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$940.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$940.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$940.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,370.33
|
|
