|
phytonadione 10 mg/ml ampule [HHSC]
|
Facility
|
IP
|
$230.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2500661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.58 |
| Max. Negotiated Rate |
$223.19 |
| Rate for Payer: Cash Price |
$149.56
|
| Rate for Payer: Health Management Network Commercial |
$195.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.08
|
| Rate for Payer: MDX Hawaii PPO |
$223.19
|
|
|
phytonadione 10 mg/ml ampule [HHSC]
|
Facility
|
OP
|
$230.09
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2500661
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$223.19 |
| Rate for Payer: AlohaCare Medicaid |
$115.05
|
| Rate for Payer: AlohaCare Medicare |
$115.05
|
| Rate for Payer: Cash Price |
$149.56
|
| Rate for Payer: Cash Price |
$149.56
|
| Rate for Payer: Devoted Health Medicare |
$126.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$218.59
|
| Rate for Payer: Health Management Network Commercial |
$195.58
|
| Rate for Payer: Humana Medicare |
$115.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.05
|
| Rate for Payer: MDX Hawaii PPO |
$223.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.05
|
| Rate for Payer: University Health Alliance Commercial |
$167.71
|
|
|
phytonadione 1 mg/0.5 ml ampule [HHSC]
|
Facility
|
OP
|
$31.08
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2500660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: AlohaCare Medicaid |
$15.54
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Devoted Health Medicare |
$17.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.53
|
| Rate for Payer: Health Management Network Commercial |
$26.42
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.54
|
| Rate for Payer: MDX Hawaii PPO |
$30.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$22.65
|
|
|
phytonadione 1 mg/0.5 ml ampule [HHSC]
|
Facility
|
IP
|
$31.08
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2500660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Cash Price |
$20.20
|
| Rate for Payer: Health Management Network Commercial |
$26.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.97
|
| Rate for Payer: MDX Hawaii PPO |
$30.15
|
|
|
PICC line insertion w USN guidance, < 5 y.o.
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 36572
|
| Hospital Charge Code |
8515466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,359.11 |
| Rate for Payer: AlohaCare Medicaid |
$1,731.50
|
| Rate for Payer: AlohaCare Medicare |
$1,731.50
|
| Rate for Payer: Cash Price |
$2,250.95
|
| Rate for Payer: Cash Price |
$2,250.95
|
| Rate for Payer: Cash Price |
$2,250.95
|
| Rate for Payer: Devoted Health Medicare |
$1,904.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,731.50
|
| Rate for Payer: Health Management Network Commercial |
$2,943.55
|
| Rate for Payer: Humana Medicare |
$1,731.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,116.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,731.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,359.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,731.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,731.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,731.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,939.28
|
|
|
PICC line insertion w USN guidance, < 5 y.o.
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 36572
|
| Hospital Charge Code |
8515466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,943.55 |
| Max. Negotiated Rate |
$3,359.11 |
| Rate for Payer: Cash Price |
$2,250.95
|
| Rate for Payer: Health Management Network Commercial |
$2,943.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,116.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,359.11
|
|
|
PICC line insertion, w USN Guidance, >= 5 y.o.
|
Facility
|
IP
|
$3,667.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
8515467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,116.95 |
| Max. Negotiated Rate |
$3,556.99 |
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Health Management Network Commercial |
$3,116.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,300.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,556.99
|
|
|
PICC line insertion, w USN Guidance, >= 5 y.o.
|
Facility
|
OP
|
$3,667.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
8515467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$3,556.99 |
| Rate for Payer: AlohaCare Medicaid |
$1,833.50
|
| Rate for Payer: AlohaCare Medicare |
$1,833.50
|
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Devoted Health Medicare |
$2,016.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,010.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,833.50
|
| Rate for Payer: Health Management Network Commercial |
$3,116.95
|
| Rate for Payer: Humana Medicare |
$1,833.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,300.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,833.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,556.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,833.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,833.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,833.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,053.52
|
|
|
Pinworm Preparation FSI
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
8118015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: AlohaCare Medicaid |
$26.50
|
| Rate for Payer: AlohaCare Medicare |
$26.50
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Devoted Health Medicare |
$29.15
|
| 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 |
$26.50
|
| 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 |
$45.05
|
| Rate for Payer: Humana Medicare |
$26.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.50
|
| Rate for Payer: MDX Hawaii PPO |
$51.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
Pinworm Preparation FSI
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
8118015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.70
|
| Rate for Payer: MDX Hawaii PPO |
$51.41
|
|
|
piperacil-tazo 3.375 gm/50mL-NaCl premix [HHSC]
|
Facility
|
IP
|
$132.70
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2501208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$128.72 |
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Health Management Network Commercial |
$112.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.43
|
| Rate for Payer: MDX Hawaii PPO |
$128.72
|
|
|
piperacil-tazo 3.375 gm/50mL-NaCl premix [HHSC]
|
Facility
|
OP
|
$132.70
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2501208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$128.72 |
| Rate for Payer: AlohaCare Medicaid |
$66.35
|
| Rate for Payer: AlohaCare Medicare |
$66.35
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Cash Price |
$86.26
|
| Rate for Payer: Devoted Health Medicare |
$72.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.06
|
| Rate for Payer: Health Management Network Commercial |
$112.80
|
| Rate for Payer: Humana Medicare |
$66.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.35
|
| Rate for Payer: MDX Hawaii PPO |
$128.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.35
|
| Rate for Payer: University Health Alliance Commercial |
$96.73
|
|
|
piperacil-tazo 3.375 g vial [HHSC]
|
Facility
|
IP
|
$20.02
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2500667
|
|
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 |
$25.28
|
| Rate for Payer: Cash Price |
$27.18
|
| Rate for Payer: Cash Price |
$57.02
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$61.96
|
| Rate for Payer: Health Management Network Commercial |
$81.03
|
| Rate for Payer: Health Management Network Commercial |
$74.56
|
| Rate for Payer: Health Management Network Commercial |
$17.02
|
| Rate for Payer: Health Management Network Commercial |
$35.55
|
| Rate for Payer: Health Management Network Commercial |
$33.06
|
| Rate for Payer: Health Management Network Commercial |
$76.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.02
|
| Rate for Payer: MDX Hawaii PPO |
$87.24
|
| Rate for Payer: MDX Hawaii PPO |
$92.47
|
| Rate for Payer: MDX Hawaii PPO |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$85.09
|
| Rate for Payer: MDX Hawaii PPO |
$19.42
|
| Rate for Payer: MDX Hawaii PPO |
$40.57
|
|
|
piperacil-tazo 3.375 g vial [HHSC]
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2500667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: AlohaCare Medicaid |
$43.86
|
| Rate for Payer: AlohaCare Medicaid |
$20.91
|
| Rate for Payer: AlohaCare Medicaid |
$19.45
|
| Rate for Payer: AlohaCare Medicaid |
$44.97
|
| Rate for Payer: AlohaCare Medicaid |
$10.01
|
| Rate for Payer: AlohaCare Medicaid |
$47.66
|
| Rate for Payer: AlohaCare Medicare |
$47.66
|
| Rate for Payer: AlohaCare Medicare |
$43.86
|
| Rate for Payer: AlohaCare Medicare |
$10.01
|
| Rate for Payer: AlohaCare Medicare |
$19.45
|
| Rate for Payer: AlohaCare Medicare |
$20.91
|
| Rate for Payer: AlohaCare Medicare |
$44.97
|
| Rate for Payer: Cash Price |
$27.18
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$27.18
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$57.02
|
| Rate for Payer: Cash Price |
$61.96
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$61.96
|
| Rate for Payer: Cash Price |
$58.46
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$57.02
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Devoted Health Medicare |
$49.47
|
| Rate for Payer: Devoted Health Medicare |
$48.25
|
| Rate for Payer: Devoted Health Medicare |
$11.01
|
| Rate for Payer: Devoted Health Medicare |
$23.00
|
| Rate for Payer: Devoted Health Medicare |
$21.39
|
| Rate for Payer: Devoted Health Medicare |
$52.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$85.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.02
|
| Rate for Payer: Health Management Network Commercial |
$76.45
|
| Rate for Payer: Health Management Network Commercial |
$35.55
|
| Rate for Payer: Health Management Network Commercial |
$33.06
|
| Rate for Payer: Health Management Network Commercial |
$17.02
|
| Rate for Payer: Health Management Network Commercial |
$74.56
|
| Rate for Payer: Health Management Network Commercial |
$81.03
|
| Rate for Payer: Humana Medicare |
$19.45
|
| Rate for Payer: Humana Medicare |
$10.01
|
| Rate for Payer: Humana Medicare |
$20.91
|
| Rate for Payer: Humana Medicare |
$44.97
|
| Rate for Payer: Humana Medicare |
$43.86
|
| Rate for Payer: Humana Medicare |
$47.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.45
|
| Rate for Payer: MDX Hawaii PPO |
$19.42
|
| Rate for Payer: MDX Hawaii PPO |
$40.57
|
| Rate for Payer: MDX Hawaii PPO |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$85.09
|
| Rate for Payer: MDX Hawaii PPO |
$92.47
|
| Rate for Payer: MDX Hawaii PPO |
$87.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.86
|
| Rate for Payer: University Health Alliance Commercial |
$65.56
|
| Rate for Payer: University Health Alliance Commercial |
$69.49
|
| Rate for Payer: University Health Alliance Commercial |
$63.94
|
| Rate for Payer: University Health Alliance Commercial |
$14.59
|
| Rate for Payer: University Health Alliance Commercial |
$28.35
|
| Rate for Payer: University Health Alliance Commercial |
$30.48
|
|
|
piperacil-tazo 4.5 gm/100mL-NaCl premix [HHSC]
|
Facility
|
IP
|
$159.04
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2501209
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.18 |
| Max. Negotiated Rate |
$154.27 |
| Rate for Payer: Cash Price |
$103.38
|
| Rate for Payer: Health Management Network Commercial |
$135.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.14
|
| Rate for Payer: MDX Hawaii PPO |
$154.27
|
|
|
piperacil-tazo 4.5 gm/100mL-NaCl premix [HHSC]
|
Facility
|
OP
|
$159.04
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2501209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$154.27 |
| Rate for Payer: AlohaCare Medicaid |
$79.52
|
| Rate for Payer: AlohaCare Medicare |
$79.52
|
| Rate for Payer: Cash Price |
$103.38
|
| Rate for Payer: Cash Price |
$103.38
|
| Rate for Payer: Devoted Health Medicare |
$87.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$151.09
|
| Rate for Payer: Health Management Network Commercial |
$135.18
|
| Rate for Payer: Humana Medicare |
$79.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.52
|
| Rate for Payer: MDX Hawaii PPO |
$154.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.52
|
| Rate for Payer: University Health Alliance Commercial |
$115.92
|
|
|
piperacil-tazo 4.5 g vial [HHSC]
|
Facility
|
IP
|
$91.73
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2500668
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Health Management Network Commercial |
$98.52
|
| Rate for Payer: Health Management Network Commercial |
$77.97
|
| Rate for Payer: Health Management Network Commercial |
$40.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.31
|
| Rate for Payer: MDX Hawaii PPO |
$46.24
|
| Rate for Payer: MDX Hawaii PPO |
$112.42
|
| Rate for Payer: MDX Hawaii PPO |
$88.98
|
|
|
piperacil-tazo 4.5 g vial [HHSC]
|
Facility
|
OP
|
$115.90
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
2500668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$112.42 |
| Rate for Payer: AlohaCare Medicaid |
$57.95
|
| Rate for Payer: AlohaCare Medicaid |
$45.87
|
| Rate for Payer: AlohaCare Medicaid |
$23.84
|
| Rate for Payer: AlohaCare Medicare |
$23.84
|
| Rate for Payer: AlohaCare Medicare |
$57.95
|
| Rate for Payer: AlohaCare Medicare |
$45.87
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cash Price |
$75.34
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Devoted Health Medicare |
$63.74
|
| Rate for Payer: Devoted Health Medicare |
$50.45
|
| Rate for Payer: Devoted Health Medicare |
$26.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.14
|
| Rate for Payer: Health Management Network Commercial |
$77.97
|
| Rate for Payer: Health Management Network Commercial |
$98.52
|
| Rate for Payer: Health Management Network Commercial |
$40.52
|
| Rate for Payer: Humana Medicare |
$57.95
|
| Rate for Payer: Humana Medicare |
$23.84
|
| Rate for Payer: Humana Medicare |
$45.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.87
|
| Rate for Payer: MDX Hawaii PPO |
$88.98
|
| Rate for Payer: MDX Hawaii PPO |
$46.24
|
| Rate for Payer: MDX Hawaii PPO |
$112.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.87
|
| Rate for Payer: University Health Alliance Commercial |
$84.48
|
| Rate for Payer: University Health Alliance Commercial |
$34.75
|
| Rate for Payer: University Health Alliance Commercial |
$66.86
|
|
|
PLASMA BUTTON 12-30
|
Facility
|
IP
|
$1,593.00
|
|
| Hospital Charge Code |
9793353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,354.05 |
| Max. Negotiated Rate |
$1,545.21 |
| Rate for Payer: Cash Price |
$1,035.45
|
| Rate for Payer: Health Management Network Commercial |
$1,354.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,433.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,545.21
|
|
|
PLASMA BUTTON 12-30
|
Facility
|
OP
|
$1,593.00
|
|
| Hospital Charge Code |
9793353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$796.50 |
| Max. Negotiated Rate |
$1,545.21 |
| Rate for Payer: AlohaCare Medicaid |
$796.50
|
| Rate for Payer: AlohaCare Medicare |
$796.50
|
| Rate for Payer: Cash Price |
$1,035.45
|
| Rate for Payer: Devoted Health Medicare |
$876.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$796.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,513.35
|
| Rate for Payer: Health Management Network Commercial |
$1,354.05
|
| Rate for Payer: Humana Medicare |
$796.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,433.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$812.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$796.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,545.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$796.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$796.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$796.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,161.14
|
|
|
Plasma Hemoglobin FSI
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
8228909
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$44.50
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$48.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.31
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$44.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.50
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.50
|
| Rate for Payer: University Health Alliance Commercial |
$18.89
|
|
|
Plasma Hemoglobin FSI
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 83051
|
| Hospital Charge Code |
8228909
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
PLASMA LOOP MEDIUM 12-16
|
Facility
|
OP
|
$1,523.00
|
|
| Hospital Charge Code |
9793352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.50 |
| Max. Negotiated Rate |
$1,477.31 |
| Rate for Payer: AlohaCare Medicaid |
$761.50
|
| Rate for Payer: AlohaCare Medicare |
$761.50
|
| Rate for Payer: Cash Price |
$989.95
|
| Rate for Payer: Devoted Health Medicare |
$837.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$761.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,446.85
|
| Rate for Payer: Health Management Network Commercial |
$1,294.55
|
| Rate for Payer: Humana Medicare |
$761.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,370.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$776.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$761.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,477.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$761.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$761.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$761.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,110.11
|
|
|
PLASMA LOOP MEDIUM 12-16
|
Facility
|
IP
|
$1,523.00
|
|
| Hospital Charge Code |
9793352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,294.55 |
| Max. Negotiated Rate |
$1,477.31 |
| Rate for Payer: Cash Price |
$989.95
|
| Rate for Payer: Health Management Network Commercial |
$1,294.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,370.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,477.31
|
|
|
Plasma Metanephrines, Free FSI
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
10756334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.90 |
| Max. Negotiated Rate |
$188.18 |
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
|
