|
ketamine 500 mg/10ml vial [HHSC]
|
Facility
|
IP
|
$40.66
|
|
|
Service Code
|
NDC 42023011410
|
| Hospital Charge Code |
2500436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$39.44 |
| Rate for Payer: Cash Price |
$26.43
|
| Rate for Payer: Health Management Network Commercial |
$34.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.59
|
| Rate for Payer: MDX Hawaii PPO |
$39.44
|
|
|
ketamine 500 mg/10ml vial [HHSC]
|
Facility
|
OP
|
$40.66
|
|
|
Service Code
|
NDC 42023011410
|
| Hospital Charge Code |
2500436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$39.44 |
| Rate for Payer: AlohaCare Medicaid |
$20.33
|
| Rate for Payer: AlohaCare Medicare |
$20.33
|
| Rate for Payer: Cash Price |
$26.43
|
| Rate for Payer: Devoted Health Medicare |
$22.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.63
|
| Rate for Payer: Health Management Network Commercial |
$34.56
|
| Rate for Payer: Humana Medicare |
$20.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.33
|
| Rate for Payer: MDX Hawaii PPO |
$39.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.33
|
| Rate for Payer: University Health Alliance Commercial |
$29.64
|
|
|
ketamine 500 mg/10ml vial [HHSC]
|
Facility
|
IP
|
$52.41
|
|
|
Service Code
|
NDC 55150043910
|
| Hospital Charge Code |
2500436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$50.84 |
| Rate for Payer: Cash Price |
$34.07
|
| Rate for Payer: Health Management Network Commercial |
$44.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.17
|
| Rate for Payer: MDX Hawaii PPO |
$50.84
|
|
|
ketamine 500 mg/10ml vial [HHSC]
|
Facility
|
OP
|
$52.41
|
|
|
Service Code
|
NDC 55150043910
|
| Hospital Charge Code |
2500436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$50.84 |
| Rate for Payer: AlohaCare Medicaid |
$26.20
|
| Rate for Payer: AlohaCare Medicare |
$26.20
|
| Rate for Payer: Cash Price |
$34.07
|
| Rate for Payer: Devoted Health Medicare |
$28.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.79
|
| Rate for Payer: Health Management Network Commercial |
$44.55
|
| Rate for Payer: Humana Medicare |
$26.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.20
|
| Rate for Payer: MDX Hawaii PPO |
$50.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.20
|
| Rate for Payer: University Health Alliance Commercial |
$38.20
|
|
|
ketorolac 30 mg/ml vial [HHSC]
|
Facility
|
OP
|
$44.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
2500438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$43.12 |
| Rate for Payer: AlohaCare Medicaid |
$22.23
|
| Rate for Payer: AlohaCare Medicaid |
$2.33
|
| Rate for Payer: AlohaCare Medicaid |
$6.34
|
| Rate for Payer: AlohaCare Medicaid |
$3.73
|
| Rate for Payer: AlohaCare Medicaid |
$16.64
|
| Rate for Payer: AlohaCare Medicaid |
$5.84
|
| Rate for Payer: AlohaCare Medicaid |
$19.45
|
| Rate for Payer: AlohaCare Medicare |
$16.64
|
| Rate for Payer: AlohaCare Medicare |
$6.34
|
| Rate for Payer: AlohaCare Medicare |
$2.33
|
| Rate for Payer: AlohaCare Medicare |
$5.84
|
| Rate for Payer: AlohaCare Medicare |
$19.45
|
| Rate for Payer: AlohaCare Medicare |
$3.73
|
| Rate for Payer: AlohaCare Medicare |
$22.23
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cash Price |
$28.89
|
| Rate for Payer: Cash Price |
$28.89
|
| Rate for Payer: Devoted Health Medicare |
$6.42
|
| Rate for Payer: Devoted Health Medicare |
$24.45
|
| Rate for Payer: Devoted Health Medicare |
$4.11
|
| Rate for Payer: Devoted Health Medicare |
$21.39
|
| Rate for Payer: Devoted Health Medicare |
$6.97
|
| Rate for Payer: Devoted Health Medicare |
$18.31
|
| Rate for Payer: Devoted Health Medicare |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.95
|
| Rate for Payer: Health Management Network Commercial |
$37.78
|
| Rate for Payer: Health Management Network Commercial |
$28.30
|
| Rate for Payer: Health Management Network Commercial |
$33.06
|
| Rate for Payer: Health Management Network Commercial |
$6.35
|
| Rate for Payer: Health Management Network Commercial |
$10.78
|
| Rate for Payer: Health Management Network Commercial |
$9.93
|
| Rate for Payer: Health Management Network Commercial |
$3.97
|
| Rate for Payer: Humana Medicare |
$16.64
|
| Rate for Payer: Humana Medicare |
$3.73
|
| Rate for Payer: Humana Medicare |
$19.45
|
| Rate for Payer: Humana Medicare |
$2.33
|
| Rate for Payer: Humana Medicare |
$6.34
|
| Rate for Payer: Humana Medicare |
$5.84
|
| Rate for Payer: Humana Medicare |
$22.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.84
|
| Rate for Payer: MDX Hawaii PPO |
$32.29
|
| Rate for Payer: MDX Hawaii PPO |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$43.12
|
| Rate for Payer: MDX Hawaii PPO |
$4.53
|
| Rate for Payer: MDX Hawaii PPO |
$7.25
|
| Rate for Payer: MDX Hawaii PPO |
$11.33
|
| Rate for Payer: MDX Hawaii PPO |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.34
|
| Rate for Payer: University Health Alliance Commercial |
$5.44
|
| Rate for Payer: University Health Alliance Commercial |
$32.40
|
| Rate for Payer: University Health Alliance Commercial |
$28.35
|
| Rate for Payer: University Health Alliance Commercial |
$24.27
|
| Rate for Payer: University Health Alliance Commercial |
$9.24
|
| Rate for Payer: University Health Alliance Commercial |
$8.51
|
| Rate for Payer: University Health Alliance Commercial |
$3.40
|
|
|
ketorolac 30 mg/ml vial [HHSC]
|
Facility
|
IP
|
$44.45
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
2500438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$43.12 |
| Rate for Payer: Cash Price |
$28.89
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$7.59
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$3.04
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Health Management Network Commercial |
$28.30
|
| Rate for Payer: Health Management Network Commercial |
$9.93
|
| Rate for Payer: Health Management Network Commercial |
$10.78
|
| Rate for Payer: Health Management Network Commercial |
$33.06
|
| Rate for Payer: Health Management Network Commercial |
$37.78
|
| Rate for Payer: Health Management Network Commercial |
$3.97
|
| Rate for Payer: Health Management Network Commercial |
$6.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.01
|
| Rate for Payer: MDX Hawaii PPO |
$12.30
|
| Rate for Payer: MDX Hawaii PPO |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$32.29
|
| Rate for Payer: MDX Hawaii PPO |
$7.25
|
| Rate for Payer: MDX Hawaii PPO |
$4.53
|
| Rate for Payer: MDX Hawaii PPO |
$43.12
|
| Rate for Payer: MDX Hawaii PPO |
$11.33
|
|
|
ketorolac 60 mg/2 mL vial [HHSC]
|
Facility
|
IP
|
$46.20
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
2500439
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.27 |
| Max. Negotiated Rate |
$44.81 |
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$8.67
|
| Rate for Payer: Health Management Network Commercial |
$16.34
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$5.84
|
| Rate for Payer: Health Management Network Commercial |
$11.34
|
| Rate for Payer: Health Management Network Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.18
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$12.94
|
| Rate for Payer: MDX Hawaii PPO |
$10.27
|
| Rate for Payer: MDX Hawaii PPO |
$18.64
|
| Rate for Payer: MDX Hawaii PPO |
$6.66
|
|
|
ketorolac 60 mg/2 mL vial [HHSC]
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
HCPCS J1885
|
| Hospital Charge Code |
2500439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: AlohaCare Medicaid |
$9.61
|
| Rate for Payer: AlohaCare Medicaid |
$6.67
|
| Rate for Payer: AlohaCare Medicaid |
$3.44
|
| Rate for Payer: AlohaCare Medicaid |
$5.29
|
| Rate for Payer: AlohaCare Medicaid |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$3.44
|
| Rate for Payer: AlohaCare Medicare |
$6.67
|
| Rate for Payer: AlohaCare Medicare |
$9.61
|
| Rate for Payer: AlohaCare Medicare |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$5.29
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: Cash Price |
$8.67
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$8.67
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$6.88
|
| Rate for Payer: Cash Price |
$4.47
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Devoted Health Medicare |
$5.82
|
| Rate for Payer: Devoted Health Medicare |
$10.57
|
| Rate for Payer: Devoted Health Medicare |
$3.78
|
| Rate for Payer: Devoted Health Medicare |
$25.41
|
| Rate for Payer: Devoted Health Medicare |
$7.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$0.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.06
|
| Rate for Payer: Health Management Network Commercial |
$16.34
|
| Rate for Payer: Health Management Network Commercial |
$11.34
|
| Rate for Payer: Health Management Network Commercial |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$5.84
|
| Rate for Payer: Humana Medicare |
$23.10
|
| Rate for Payer: Humana Medicare |
$3.44
|
| Rate for Payer: Humana Medicare |
$6.67
|
| Rate for Payer: Humana Medicare |
$9.61
|
| Rate for Payer: Humana Medicare |
$5.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.44
|
| Rate for Payer: MDX Hawaii PPO |
$10.27
|
| Rate for Payer: MDX Hawaii PPO |
$18.64
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$6.66
|
| Rate for Payer: MDX Hawaii PPO |
$12.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.29
|
| Rate for Payer: University Health Alliance Commercial |
$7.72
|
| Rate for Payer: University Health Alliance Commercial |
$14.01
|
| Rate for Payer: University Health Alliance Commercial |
$9.72
|
| Rate for Payer: University Health Alliance Commercial |
$5.01
|
| Rate for Payer: University Health Alliance Commercial |
$33.68
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC
|
Facility
|
IP
|
$43,279.85
|
|
|
Service Code
|
MSDRG 657
|
| Min. Negotiated Rate |
$43,279.85 |
| Max. Negotiated Rate |
$43,279.85 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43,279.85
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC
|
Facility
|
IP
|
$43,279.85
|
|
|
Service Code
|
MSDRG 656
|
| Min. Negotiated Rate |
$43,279.85 |
| Max. Negotiated Rate |
$43,279.85 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43,279.85
|
|
|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$43,279.85
|
|
|
Service Code
|
MSDRG 658
|
| Min. Negotiated Rate |
$43,279.85 |
| Max. Negotiated Rate |
$43,279.85 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43,279.85
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$46,052.99
|
|
|
Service Code
|
MSDRG 660
|
| Min. Negotiated Rate |
$46,052.99 |
| Max. Negotiated Rate |
$46,052.99 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46,052.99
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
|
Facility
|
IP
|
$47,759.53
|
|
|
Service Code
|
MSDRG 659
|
| Min. Negotiated Rate |
$47,759.53 |
| Max. Negotiated Rate |
$47,759.53 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47,759.53
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$31,144.43
|
|
|
Service Code
|
MSDRG 661
|
| Min. Negotiated Rate |
$31,144.43 |
| Max. Negotiated Rate |
$31,144.43 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31,144.43
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC
|
Facility
|
IP
|
$17,539.48
|
|
|
Service Code
|
MSDRG 689
|
| Min. Negotiated Rate |
$17,539.48 |
| Max. Negotiated Rate |
$17,539.48 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,539.48
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$14,979.66
|
|
|
Service Code
|
MSDRG 690
|
| Min. Negotiated Rate |
$14,979.66 |
| Max. Negotiated Rate |
$14,979.66 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,979.66
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC
|
Facility
|
IP
|
$30,931.11
|
|
|
Service Code
|
MSDRG 687
|
| Min. Negotiated Rate |
$30,931.11 |
| Max. Negotiated Rate |
$30,931.11 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30,931.11
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC
|
Facility
|
IP
|
$30,931.11
|
|
|
Service Code
|
MSDRG 686
|
| Min. Negotiated Rate |
$30,931.11 |
| Max. Negotiated Rate |
$30,931.11 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30,931.11
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$30,931.11
|
|
|
Service Code
|
MSDRG 688
|
| Min. Negotiated Rate |
$30,931.11 |
| Max. Negotiated Rate |
$30,931.11 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30,931.11
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$20,525.93
|
|
|
Service Code
|
MSDRG 695
|
| Min. Negotiated Rate |
$20,525.93 |
| Max. Negotiated Rate |
$20,525.93 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,525.93
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$20,525.93
|
|
|
Service Code
|
MSDRG 696
|
| Min. Negotiated Rate |
$20,525.93 |
| Max. Negotiated Rate |
$20,525.93 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,525.93
|
|
|
Kidney Stone Risk Profile FSI
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
10046577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$208.55 |
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.50
|
| Rate for Payer: MDX Hawaii PPO |
$208.55
|
|
|
Kidney Stone Risk Profile FSI
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
10046577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$208.55 |
| Rate for Payer: AlohaCare Medicaid |
$107.50
|
| Rate for Payer: AlohaCare Medicare |
$107.50
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Devoted Health Medicare |
$118.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.90
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Humana Medicare |
$107.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.50
|
| Rate for Payer: MDX Hawaii PPO |
$208.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.50
|
| Rate for Payer: University Health Alliance Commercial |
$21.40
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$154,726.66
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$154,726.66 |
| Max. Negotiated Rate |
$154,726.66 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154,726.66
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$154,726.66
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$154,726.66 |
| Max. Negotiated Rate |
$154,726.66 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154,726.66
|
|
