|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
OP
|
$7.70
|
|
|
Service Code
|
NDC 60687064201
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: AlohaCare Medicaid |
$3.85
|
| Rate for Payer: AlohaCare Medicare |
$3.85
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Devoted Health Medicare |
$4.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.32
|
| Rate for Payer: Health Management Network Commercial |
$6.54
|
| Rate for Payer: Humana Medicare |
$3.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.85
|
| Rate for Payer: MDX Hawaii PPO |
$7.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.85
|
| Rate for Payer: University Health Alliance Commercial |
$5.61
|
|
|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Health Management Network Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.85
|
| Rate for Payer: MDX Hawaii PPO |
$7.38
|
|
|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
IP
|
$7.60
|
|
|
Service Code
|
NDC 50268064415
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Health Management Network Commercial |
$6.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.84
|
| Rate for Payer: MDX Hawaii PPO |
$7.37
|
|
|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
OP
|
$7.60
|
|
|
Service Code
|
NDC 50268064415
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: AlohaCare Medicaid |
$3.80
|
| Rate for Payer: AlohaCare Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$4.94
|
| Rate for Payer: Devoted Health Medicare |
$4.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.22
|
| Rate for Payer: Health Management Network Commercial |
$6.46
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.80
|
| Rate for Payer: MDX Hawaii PPO |
$7.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.80
|
| Rate for Payer: University Health Alliance Commercial |
$5.54
|
|
|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
IP
|
$7.70
|
|
|
Service Code
|
NDC 60687064201
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Health Management Network Commercial |
$6.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.93
|
| Rate for Payer: MDX Hawaii PPO |
$7.47
|
|
|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 00406051201
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Health Management Network Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.85
|
| Rate for Payer: MDX Hawaii PPO |
$7.38
|
|
|
oxyCODONE-APAP 5-325 mg tablet [HHSC]
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 42858010201
|
| Hospital Charge Code |
2500012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Health Management Network Commercial |
$6.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.85
|
| Rate for Payer: MDX Hawaii PPO |
$7.38
|
|
|
Oxygen Per Hour Charge
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
8449974
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$9.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Devoted Health Medicare |
$9.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$9.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.00
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
|
|
Oxygen Per Hour Charge
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
8449974
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
OXYGEN THERAPY CHARGE DAILY
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
8279005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: AlohaCare Medicaid |
$180.00
|
| Rate for Payer: AlohaCare Medicare |
$180.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Devoted Health Medicare |
$198.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network Commercial |
$306.00
|
| Rate for Payer: Humana Medicare |
$180.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$183.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.00
|
| Rate for Payer: MDX Hawaii PPO |
$349.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.00
|
| Rate for Payer: University Health Alliance Commercial |
$262.40
|
|
|
OXYGEN THERAPY CHARGE DAILY
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
8279005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Health Management Network Commercial |
$306.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.00
|
| Rate for Payer: MDX Hawaii PPO |
$349.20
|
|
|
Oxygen Therapy High-Flow Nasal Cannula
|
Facility
|
OP
|
$532.00
|
|
| Hospital Charge Code |
9277861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$516.04 |
| Rate for Payer: AlohaCare Medicaid |
$266.00
|
| Rate for Payer: AlohaCare Medicare |
$266.00
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Devoted Health Medicare |
$292.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$505.40
|
| Rate for Payer: Health Management Network Commercial |
$452.20
|
| Rate for Payer: Humana Medicare |
$266.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$478.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$271.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.00
|
| Rate for Payer: MDX Hawaii PPO |
$516.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.00
|
| Rate for Payer: University Health Alliance Commercial |
$387.77
|
|
|
Oxygen Therapy High-Flow Nasal Cannula
|
Facility
|
IP
|
$532.00
|
|
| Hospital Charge Code |
9277861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$516.04 |
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Health Management Network Commercial |
$452.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$478.80
|
| Rate for Payer: MDX Hawaii PPO |
$516.04
|
|
|
Oxygen Therapy Low-Flow Nasal Cannula
|
Facility
|
IP
|
$532.00
|
|
| Hospital Charge Code |
9277862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$516.04 |
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Health Management Network Commercial |
$452.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$478.80
|
| Rate for Payer: MDX Hawaii PPO |
$516.04
|
|
|
Oxygen Therapy Low-Flow Nasal Cannula
|
Facility
|
OP
|
$532.00
|
|
| Hospital Charge Code |
9277862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$516.04 |
| Rate for Payer: AlohaCare Medicaid |
$266.00
|
| Rate for Payer: AlohaCare Medicare |
$266.00
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Devoted Health Medicare |
$292.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$505.40
|
| Rate for Payer: Health Management Network Commercial |
$452.20
|
| Rate for Payer: Humana Medicare |
$266.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$478.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$271.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.00
|
| Rate for Payer: MDX Hawaii PPO |
$516.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.00
|
| Rate for Payer: University Health Alliance Commercial |
$387.77
|
|
|
oxymetazoline 0.05% 15ml spray nasal [HHSC]
|
Facility
|
IP
|
$26.63
|
|
|
Service Code
|
NDC 11523411201
|
| Hospital Charge Code |
2500626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Health Management Network Commercial |
$22.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.97
|
| Rate for Payer: MDX Hawaii PPO |
$25.83
|
|
|
oxymetazoline 0.05% 15ml spray nasal [HHSC]
|
Facility
|
IP
|
$11.40
|
|
|
Service Code
|
NDC 00904571135
|
| Hospital Charge Code |
2500626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Health Management Network Commercial |
$9.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.26
|
| Rate for Payer: MDX Hawaii PPO |
$11.06
|
|
|
oxymetazoline 0.05% 15ml spray nasal [HHSC]
|
Facility
|
OP
|
$26.63
|
|
|
Service Code
|
NDC 11523411201
|
| Hospital Charge Code |
2500626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: AlohaCare Medicaid |
$13.31
|
| Rate for Payer: AlohaCare Medicare |
$13.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Devoted Health Medicare |
$14.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.30
|
| Rate for Payer: Health Management Network Commercial |
$22.64
|
| Rate for Payer: Humana Medicare |
$13.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.31
|
| Rate for Payer: MDX Hawaii PPO |
$25.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.31
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
oxymetazoline 0.05% 15ml spray nasal [HHSC]
|
Facility
|
IP
|
$27.96
|
|
|
Service Code
|
NDC 11523116706
|
| Hospital Charge Code |
2500626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$27.12 |
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Health Management Network Commercial |
$23.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.16
|
| Rate for Payer: MDX Hawaii PPO |
$27.12
|
|
|
oxymetazoline 0.05% 15ml spray nasal [HHSC]
|
Facility
|
OP
|
$11.40
|
|
|
Service Code
|
NDC 00904571135
|
| Hospital Charge Code |
2500626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: AlohaCare Medicaid |
$5.70
|
| Rate for Payer: AlohaCare Medicare |
$5.70
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Devoted Health Medicare |
$6.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.83
|
| Rate for Payer: Health Management Network Commercial |
$9.69
|
| Rate for Payer: Humana Medicare |
$5.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.70
|
| Rate for Payer: MDX Hawaii PPO |
$11.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.70
|
| Rate for Payer: University Health Alliance Commercial |
$8.31
|
|
|
oxymetazoline 0.05% 15ml spray nasal [HHSC]
|
Facility
|
OP
|
$27.96
|
|
|
Service Code
|
NDC 11523116706
|
| Hospital Charge Code |
2500626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$27.12 |
| Rate for Payer: AlohaCare Medicaid |
$13.98
|
| Rate for Payer: AlohaCare Medicare |
$13.98
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Devoted Health Medicare |
$15.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.56
|
| Rate for Payer: Health Management Network Commercial |
$23.77
|
| Rate for Payer: Humana Medicare |
$13.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.98
|
| Rate for Payer: MDX Hawaii PPO |
$27.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.98
|
| Rate for Payer: University Health Alliance Commercial |
$20.38
|
|
|
oxytocin 10 unit/1 ml vial [HHSC]
|
Facility
|
OP
|
$24.02
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2500627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: AlohaCare Medicaid |
$12.01
|
| Rate for Payer: AlohaCare Medicaid |
$4.97
|
| Rate for Payer: AlohaCare Medicaid |
$10.01
|
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$10.01
|
| Rate for Payer: AlohaCare Medicare |
$12.01
|
| Rate for Payer: AlohaCare Medicare |
$4.97
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Devoted Health Medicare |
$11.01
|
| Rate for Payer: Devoted Health Medicare |
$13.21
|
| Rate for Payer: Devoted Health Medicare |
$5.51
|
| Rate for Payer: Devoted Health Medicare |
$5.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$8.45
|
| Rate for Payer: Health Management Network Commercial |
$17.02
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Health Management Network Commercial |
$20.42
|
| Rate for Payer: Humana Medicare |
$10.01
|
| Rate for Payer: Humana Medicare |
$5.00
|
| Rate for Payer: Humana Medicare |
$12.01
|
| Rate for Payer: Humana Medicare |
$4.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.64
|
| Rate for Payer: MDX Hawaii PPO |
$23.30
|
| Rate for Payer: MDX Hawaii PPO |
$19.42
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.00
|
| Rate for Payer: University Health Alliance Commercial |
$7.25
|
| Rate for Payer: University Health Alliance Commercial |
$17.51
|
| Rate for Payer: University Health Alliance Commercial |
$7.30
|
| Rate for Payer: University Health Alliance Commercial |
$14.59
|
|
|
oxytocin 10 unit/1 ml vial [HHSC]
|
Facility
|
IP
|
$20.02
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2500627
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$19.42 |
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Health Management Network Commercial |
$17.02
|
| Rate for Payer: Health Management Network Commercial |
$20.42
|
| Rate for Payer: Health Management Network Commercial |
$8.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.02
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: MDX Hawaii PPO |
$23.30
|
| Rate for Payer: MDX Hawaii PPO |
$9.64
|
| Rate for Payer: MDX Hawaii PPO |
$19.42
|
|
|
P9012 Cryoprecipitate Ea Unit
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
8258886
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.10
|
| Rate for Payer: MDX Hawaii PPO |
$222.13
|
|
|
P9012 Cryoprecipitate Ea Unit
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
8258886
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: AlohaCare Medicaid |
$114.50
|
| Rate for Payer: AlohaCare Medicare |
$114.50
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Devoted Health Medicare |
$125.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.55
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Humana Medicare |
$114.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.50
|
| Rate for Payer: MDX Hawaii PPO |
$222.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.50
|
| Rate for Payer: University Health Alliance Commercial |
$128.24
|
|
