|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [127636]
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS J2598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$79.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.25
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.84
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: MDX Hawaii PPO |
$81.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.00
|
| Rate for Payer: University Health Alliance Commercial |
$40.09
|
| Rate for Payer: University Health Alliance Commercial |
$61.23
|
|
|
VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION [127636]
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS J2598
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: MDX Hawaii PPO |
$81.48
|
|
|
VCARE LRG CUP 60-6085-202A
|
Facility
|
OP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.55
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.99
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
| Rate for Payer: University Health Alliance Commercial |
$254.39
|
|
|
VCARE LRG CUP 60-6085-202A
|
Facility
|
IP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.65 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
|
|
VCARE MED CUP 60-6085-201A
|
Facility
|
IP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.65 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
|
|
VCARE MED CUP 60-6085-201A
|
Facility
|
OP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.55
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.99
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
| Rate for Payer: University Health Alliance Commercial |
$254.39
|
|
|
VCARE SMALL CUP 60-6085-200A
|
Facility
|
IP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.65 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
|
|
VCARE SMALL CUP 60-6085-200A
|
Facility
|
OP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.55
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.99
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
| Rate for Payer: University Health Alliance Commercial |
$254.39
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 55150023510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 47335093144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 25021068510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 67457043810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: MDX Hawaii PPO |
$20.37
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 55150023501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [126219]
|
Facility
|
IP
|
$11,732.00
|
|
|
Service Code
|
HCPCS J3380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9,972.20 |
| Max. Negotiated Rate |
$11,380.04 |
| Rate for Payer: Cash Price |
$7,039.20
|
| Rate for Payer: Health Management Network Commercial |
$9,972.20
|
| Rate for Payer: MDX Hawaii PPO |
$11,380.04
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [126219]
|
Facility
|
OP
|
$11,732.00
|
|
|
Service Code
|
HCPCS J3380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$11,380.04 |
| Rate for Payer: AlohaCare Medicaid |
$20.98
|
| Rate for Payer: AlohaCare Medicare |
$20.98
|
| Rate for Payer: Cash Price |
$7,039.20
|
| Rate for Payer: Cash Price |
$7,039.20
|
| Rate for Payer: Devoted Health Medicare |
$23.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,145.40
|
| Rate for Payer: Health Management Network Commercial |
$9,972.20
|
| Rate for Payer: Humana Medicare |
$20.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,391.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,983.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.98
|
| Rate for Payer: MDX Hawaii PPO |
$11,380.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7,039.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.98
|
| Rate for Payer: University Health Alliance Commercial |
$8,551.45
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$52,740.15
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$33,681.21 |
| Max. Negotiated Rate |
$52,740.15 |
| Rate for Payer: AlohaCare Medicare |
$34,775.65
|
| Rate for Payer: Devoted Health Medicare |
$38,253.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33,681.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34,775.65
|
| Rate for Payer: Humana Medicare |
$34,775.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$52,740.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$34,775.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$34,775.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$34,775.65
|
|
|
VEIN STRIPPER
|
Facility
|
IP
|
$228.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
|
VEIN STRIPPER
|
Facility
|
OP
|
$228.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.28 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$216.60
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: University Health Alliance Commercial |
$166.19
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68084089695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68084089625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 68001015700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68084089625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 23155024601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68001015700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 23155024601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
