|
YOUNGSWICK 1MM ACCUCUT 19506
|
Facility
|
IP
|
$469.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
YOUNGSWICK 2MM ACCUCUT 19507
|
Facility
|
OP
|
$469.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.19 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: University Health Alliance Commercial |
$341.85
|
|
|
YOUNGSWICK 2MM ACCUCUT 19507
|
Facility
|
IP
|
$469.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
YOUNGSWICK 3MM ACCUCUT 19508
|
Facility
|
IP
|
$469.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
|
YOUNGSWICK 3MM ACCUCUT 19508
|
Facility
|
OP
|
$469.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.19 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: University Health Alliance Commercial |
$341.85
|
|
|
YTTRIUM-90 THERASPHERE [4080084]
|
Facility
|
IP
|
$26,227.00
|
|
|
Service Code
|
HCPCS C2616
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22,292.95 |
| Max. Negotiated Rate |
$25,440.19 |
| Rate for Payer: Cash Price |
$15,736.20
|
| Rate for Payer: Cash Price |
$18,823.80
|
| Rate for Payer: Health Management Network Commercial |
$26,667.05
|
| Rate for Payer: Health Management Network Commercial |
$22,292.95
|
| Rate for Payer: MDX Hawaii PPO |
$25,440.19
|
| Rate for Payer: MDX Hawaii PPO |
$30,431.81
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION [11691]
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS J3485
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$119.31 |
| Rate for Payer: AlohaCare Medicaid |
$1.51
|
| Rate for Payer: AlohaCare Medicaid |
$1.51
|
| Rate for Payer: AlohaCare Medicaid |
$1.51
|
| Rate for Payer: AlohaCare Medicaid |
$1.51
|
| Rate for Payer: AlohaCare Medicare |
$1.51
|
| Rate for Payer: AlohaCare Medicare |
$1.51
|
| Rate for Payer: AlohaCare Medicare |
$1.51
|
| Rate for Payer: AlohaCare Medicare |
$1.51
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$1.66
|
| Rate for Payer: Devoted Health Medicare |
$1.66
|
| Rate for Payer: Devoted Health Medicare |
$1.66
|
| Rate for Payer: Devoted Health Medicare |
$1.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.00
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Humana Medicare |
$1.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.51
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: MDX Hawaii PPO |
$119.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.51
|
| Rate for Payer: University Health Alliance Commercial |
$29.16
|
| Rate for Payer: University Health Alliance Commercial |
$89.65
|
| Rate for Payer: University Health Alliance Commercial |
$79.45
|
| Rate for Payer: University Health Alliance Commercial |
$19.68
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION [11691]
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J3485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: MDX Hawaii PPO |
$119.31
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
NDC 49702021248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: University Health Alliance Commercial |
$113.71
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
NDC 65862004824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.35
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.63
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
| Rate for Payer: University Health Alliance Commercial |
$82.37
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
NDC 49702021248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP [11693]
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
NDC 65862004824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT [8874]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 00536131628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT [8874]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 00536131628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE [111153]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
NDC 74300000071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.65
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: University Health Alliance Commercial |
$19.68
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE [111153]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
NDC 74300000071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 98325000000
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 98310000000
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 98310000000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 98325000000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
ZIPRASIDONE 20 MG CAPSULE [29778]
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 68084010309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
|
|
ZIPRASIDONE 20 MG CAPSULE [29778]
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 68084010311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: University Health Alliance Commercial |
$18.95
|
|
|
ZIPRASIDONE 20 MG CAPSULE [29778]
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 68084010309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: University Health Alliance Commercial |
$18.95
|
|
|
ZIPRASIDONE 20 MG CAPSULE [29778]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
NDC 68001045006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.65
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: University Health Alliance Commercial |
$19.68
|
|
|
ZIPRASIDONE 20 MG CAPSULE [29778]
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
NDC 68001045006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
