|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
OP
|
$479.96
|
|
|
Service Code
|
NDC 00065063827
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$239.98 |
| Max. Negotiated Rate |
$465.56 |
| Rate for Payer: AlohaCare Medicaid |
$239.98
|
| Rate for Payer: AlohaCare Medicare |
$239.98
|
| Rate for Payer: Cash Price |
$311.97
|
| Rate for Payer: Devoted Health Medicare |
$263.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$455.96
|
| Rate for Payer: Health Management Network Commercial |
$407.97
|
| Rate for Payer: Humana Medicare |
$239.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.98
|
| Rate for Payer: MDX Hawaii PPO |
$465.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$287.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.98
|
| Rate for Payer: University Health Alliance Commercial |
$349.84
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
OP
|
$284.17
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.09 |
| Max. Negotiated Rate |
$275.64 |
| Rate for Payer: AlohaCare Medicaid |
$142.09
|
| Rate for Payer: AlohaCare Medicare |
$142.09
|
| Rate for Payer: Cash Price |
$184.71
|
| Rate for Payer: Devoted Health Medicare |
$156.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$269.96
|
| Rate for Payer: Health Management Network Commercial |
$241.54
|
| Rate for Payer: Humana Medicare |
$142.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$255.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.09
|
| Rate for Payer: MDX Hawaii PPO |
$275.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.09
|
| Rate for Payer: University Health Alliance Commercial |
$207.13
|
|
|
predniSONE 10 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
2500694
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
predniSONE 10 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
2500694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
predniSONE 20 mg tablet [HHSC]
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
2500695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$7.10
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.51
|
| Rate for Payer: MDX Hawaii PPO |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
predniSONE 20 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
2500695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicaid |
$4.17
|
| Rate for Payer: AlohaCare Medicare |
$4.17
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Devoted Health Medicare |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.93
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$7.10
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Humana Medicare |
$4.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$8.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.17
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
| Rate for Payer: University Health Alliance Commercial |
$6.09
|
|
|
Pregnancy Toxoplasma IgG and IgM with Reflex FSI
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
9754668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
Pregnancy Toxoplasma IgG and IgM with Reflex FSI
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
9754668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$82.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$90.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Pregnenolone FSI
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 84140
|
| Hospital Charge Code |
10075144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
|
|
Pregnenolone FSI
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 84140
|
| Hospital Charge Code |
10075144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: AlohaCare Medicaid |
$77.00
|
| Rate for Payer: AlohaCare Medicare |
$77.00
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Devoted Health Medicare |
$84.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.67
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Humana Medicare |
$77.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.00
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.00
|
| Rate for Payer: University Health Alliance Commercial |
$53.45
|
|
|
PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$61,577.80
|
|
|
Service Code
|
MSDRG 791
|
| Min. Negotiated Rate |
$61,577.80 |
| Max. Negotiated Rate |
$61,577.80 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$61,577.80
|
|
|
PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$12,325.04
|
|
|
Service Code
|
MSDRG 792
|
| Min. Negotiated Rate |
$12,325.04 |
| Max. Negotiated Rate |
$12,325.04 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,325.04
|
|
|
Prenatal III Panel (CBC, RPR, RBGG, HBSAg, ABORH, Ab Screen) FSI
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
8118018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$200.79 |
| Rate for Payer: AlohaCare Medicaid |
$103.50
|
| Rate for Payer: AlohaCare Medicare |
$103.50
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Devoted Health Medicare |
$113.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$175.95
|
| Rate for Payer: Humana Medicare |
$103.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.50
|
| Rate for Payer: MDX Hawaii PPO |
$200.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Prenatal III Panel (CBC, RPR, RBGG, HBSAg, ABORH, Ab Screen) FSI
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
8118018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$200.79 |
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Health Management Network Commercial |
$175.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.30
|
| Rate for Payer: MDX Hawaii PPO |
$200.79
|
|
|
Preterm Labor Trmt Addl Hr Charge
|
Facility
|
IP
|
$389.00
|
|
| Hospital Charge Code |
8140421
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
|
Preterm Labor Trmt Addl Hr Charge
|
Facility
|
OP
|
$389.00
|
|
| Hospital Charge Code |
8140421
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$194.50 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: AlohaCare Medicaid |
$194.50
|
| Rate for Payer: AlohaCare Medicare |
$194.50
|
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Devoted Health Medicare |
$213.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$369.55
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$194.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.50
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.50
|
| Rate for Payer: University Health Alliance Commercial |
$217.84
|
|
|
Preterm Labor Trmt Initial Hr Charge
|
Facility
|
IP
|
$510.00
|
|
| Hospital Charge Code |
8140422
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$433.50 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
|
|
Preterm Labor Trmt Initial Hr Charge
|
Facility
|
OP
|
$510.00
|
|
| Hospital Charge Code |
8140422
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: AlohaCare Medicaid |
$255.00
|
| Rate for Payer: AlohaCare Medicare |
$255.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Devoted Health Medicare |
$280.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$484.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Humana Medicare |
$255.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.00
|
| Rate for Payer: University Health Alliance Commercial |
$285.60
|
|
|
PRIMO FIT EXTERNAL URINE MANAGEMENT FOR MALE
|
Facility
|
IP
|
$183.00
|
|
| Hospital Charge Code |
9467532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.55 |
| Max. Negotiated Rate |
$177.51 |
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.70
|
| Rate for Payer: MDX Hawaii PPO |
$177.51
|
|
|
PRIMO FIT EXTERNAL URINE MANAGEMENT FOR MALE
|
Facility
|
OP
|
$183.00
|
|
| Hospital Charge Code |
9467532
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$177.51 |
| Rate for Payer: AlohaCare Medicaid |
$91.50
|
| Rate for Payer: AlohaCare Medicare |
$91.50
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Devoted Health Medicare |
$100.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$173.85
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| Rate for Payer: Humana Medicare |
$91.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.50
|
| Rate for Payer: MDX Hawaii PPO |
$177.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.50
|
| Rate for Payer: University Health Alliance Commercial |
$133.39
|
|
|
procainamide 1000 mg/10 ml vial [HHSC]
|
Facility
|
IP
|
$430.04
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
2500696
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$365.53 |
| Max. Negotiated Rate |
$417.14 |
| Rate for Payer: Cash Price |
$279.53
|
| Rate for Payer: Cash Price |
$343.14
|
| Rate for Payer: Health Management Network Commercial |
$365.53
|
| Rate for Payer: Health Management Network Commercial |
$448.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$475.12
|
| Rate for Payer: MDX Hawaii PPO |
$512.07
|
| Rate for Payer: MDX Hawaii PPO |
$417.14
|
|
|
procainamide 1000 mg/10 ml vial [HHSC]
|
Facility
|
OP
|
$430.04
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
2500696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.32 |
| Max. Negotiated Rate |
$417.14 |
| Rate for Payer: AlohaCare Medicaid |
$215.02
|
| Rate for Payer: AlohaCare Medicaid |
$263.95
|
| Rate for Payer: AlohaCare Medicare |
$263.95
|
| Rate for Payer: AlohaCare Medicare |
$215.02
|
| Rate for Payer: Cash Price |
$343.14
|
| Rate for Payer: Cash Price |
$279.53
|
| Rate for Payer: Cash Price |
$343.14
|
| Rate for Payer: Cash Price |
$279.53
|
| Rate for Payer: Devoted Health Medicare |
$236.52
|
| Rate for Payer: Devoted Health Medicare |
$290.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$194.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$194.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$268.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$268.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$263.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$408.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$501.51
|
| Rate for Payer: Health Management Network Commercial |
$448.72
|
| Rate for Payer: Health Management Network Commercial |
$365.53
|
| Rate for Payer: Humana Medicare |
$215.02
|
| Rate for Payer: Humana Medicare |
$263.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$475.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$263.95
|
| Rate for Payer: MDX Hawaii PPO |
$417.14
|
| Rate for Payer: MDX Hawaii PPO |
$512.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$263.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$263.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$316.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$258.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$263.95
|
| Rate for Payer: University Health Alliance Commercial |
$313.46
|
| Rate for Payer: University Health Alliance Commercial |
$384.79
|
|
|
Procalcitonin REF
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
8160204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: AlohaCare Medicaid |
$159.50
|
| Rate for Payer: AlohaCare Medicare |
$159.50
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Devoted Health Medicare |
$175.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Humana Medicare |
$159.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.50
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.50
|
| Rate for Payer: University Health Alliance Commercial |
$51.36
|
|
|
Procalcitonin REF
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
8160204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
|
|
prochlorperazine 10 mg/2 ml vial [HHSC]
|
Facility
|
OP
|
$110.95
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
2500699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$107.62 |
| Rate for Payer: AlohaCare Medicaid |
$55.48
|
| Rate for Payer: AlohaCare Medicaid |
$20.32
|
| Rate for Payer: AlohaCare Medicare |
$20.32
|
| Rate for Payer: AlohaCare Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$72.12
|
| Rate for Payer: Cash Price |
$72.12
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Devoted Health Medicare |
$61.02
|
| Rate for Payer: Devoted Health Medicare |
$22.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.62
|
| Rate for Payer: Health Management Network Commercial |
$34.55
|
| Rate for Payer: Health Management Network Commercial |
$94.31
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Humana Medicare |
$20.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.32
|
| Rate for Payer: MDX Hawaii PPO |
$107.62
|
| Rate for Payer: MDX Hawaii PPO |
$39.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.32
|
| Rate for Payer: University Health Alliance Commercial |
$80.87
|
| Rate for Payer: University Health Alliance Commercial |
$29.63
|
|
