|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS J2430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$238.85 |
| Max. Negotiated Rate |
$272.57 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Health Management Network Commercial |
$238.85
|
| Rate for Payer: MDX Hawaii PPO |
$272.57
|
|
|
PAMIDRONATE 90 MG/10 ML (9 MG/ML) INTRAVENOUS SOLUTION [32855]
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS J2430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$272.57 |
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.95
|
| Rate for Payer: Health Management Network Commercial |
$238.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.31
|
| Rate for Payer: MDX Hawaii PPO |
$272.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.60
|
| Rate for Payer: University Health Alliance Commercial |
$204.82
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$52,875.61
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$32,987.61 |
| Max. Negotiated Rate |
$52,875.61 |
| Rate for Payer: AlohaCare Medicare |
$32,987.61
|
| Rate for Payer: Devoted Health Medicare |
$36,286.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52,875.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32,987.61
|
| Rate for Payer: Humana Medicare |
$32,987.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$50,028.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$32,987.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$32,987.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$32,987.61
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$95,656.57
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$62,222.86 |
| Max. Negotiated Rate |
$95,656.57 |
| Rate for Payer: AlohaCare Medicare |
$62,222.86
|
| Rate for Payer: Devoted Health Medicare |
$68,445.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$95,656.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62,222.86
|
| Rate for Payer: Humana Medicare |
$62,222.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$94,366.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$62,222.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$62,222.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$62,222.86
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,288.10
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$25,246.29 |
| Max. Negotiated Rate |
$38,288.10 |
| Rate for Payer: AlohaCare Medicare |
$25,246.29
|
| Rate for Payer: Devoted Health Medicare |
$27,770.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37,903.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25,246.29
|
| Rate for Payer: Humana Medicare |
$25,246.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$38,288.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$25,246.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$25,246.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$25,246.29
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$44,001.95
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$44,001.95 |
| Max. Negotiated Rate |
$44,001.95 |
| Rate for Payer: AlohaCare Medicaid |
$44,001.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44,001.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44,001.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44,001.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44,001.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44,001.95
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$30,163.25
|
|
|
Service Code
|
APR-DRG 0061
|
| Min. Negotiated Rate |
$30,163.25 |
| Max. Negotiated Rate |
$30,163.25 |
| Rate for Payer: AlohaCare Medicaid |
$30,163.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30,163.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30,163.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30,163.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30,163.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30,163.25
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$89,780.07
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$89,780.07 |
| Rate for Payer: AlohaCare Medicare |
$81,618.25
|
| Rate for Payer: Devoted Health Medicare |
$89,780.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81,618.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$52,955.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$81,618.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$81,618.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$81,618.25
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$74,580.70
|
|
|
Service Code
|
APR-DRG 0064
|
| Min. Negotiated Rate |
$74,580.70 |
| Max. Negotiated Rate |
$74,580.70 |
| Rate for Payer: AlohaCare Medicaid |
$74,580.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$74,580.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$74,580.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74,580.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74,580.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74,580.70
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$52,132.59
|
|
|
Service Code
|
APR-DRG 0063
|
| Min. Negotiated Rate |
$52,132.59 |
| Max. Negotiated Rate |
$52,132.59 |
| Rate for Payer: AlohaCare Medicaid |
$52,132.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52,132.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52,132.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52,132.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52,132.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52,132.59
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
IP
|
$3,261.00
|
|
|
Service Code
|
HCPCS J9303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,771.85 |
| Max. Negotiated Rate |
$3,163.17 |
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$5,048.40
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
| Rate for Payer: Health Management Network Commercial |
$2,771.85
|
| Rate for Payer: MDX Hawaii PPO |
$8,161.58
|
| Rate for Payer: MDX Hawaii PPO |
$3,163.17
|
|
|
PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION [108055]
|
Facility
|
OP
|
$3,261.00
|
|
|
Service Code
|
HCPCS J9303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.55 |
| Max. Negotiated Rate |
$3,163.17 |
| Rate for Payer: AlohaCare Medicaid |
$174.39
|
| Rate for Payer: AlohaCare Medicaid |
$174.39
|
| Rate for Payer: AlohaCare Medicare |
$174.39
|
| Rate for Payer: AlohaCare Medicare |
$174.39
|
| Rate for Payer: Cash Price |
$5,048.40
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$1,956.60
|
| Rate for Payer: Cash Price |
$5,048.40
|
| Rate for Payer: Devoted Health Medicare |
$191.83
|
| Rate for Payer: Devoted Health Medicare |
$191.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,097.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,993.30
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
| Rate for Payer: Health Management Network Commercial |
$2,771.85
|
| Rate for Payer: Humana Medicare |
$174.39
|
| Rate for Payer: Humana Medicare |
$174.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,300.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,054.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,663.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,291.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.39
|
| Rate for Payer: MDX Hawaii PPO |
$8,161.58
|
| Rate for Payer: MDX Hawaii PPO |
$3,163.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,956.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,048.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.39
|
| Rate for Payer: University Health Alliance Commercial |
$6,132.96
|
| Rate for Payer: University Health Alliance Commercial |
$2,376.94
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
IP
|
$13,044.00
|
|
|
Service Code
|
HCPCS J9303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11,087.40 |
| Max. Negotiated Rate |
$12,652.68 |
| Rate for Payer: Cash Price |
$7,826.40
|
| Rate for Payer: Health Management Network Commercial |
$11,087.40
|
| Rate for Payer: MDX Hawaii PPO |
$12,652.68
|
|
|
PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION [108057]
|
Facility
|
OP
|
$13,044.00
|
|
|
Service Code
|
HCPCS J9303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$172.55 |
| Max. Negotiated Rate |
$12,652.68 |
| Rate for Payer: AlohaCare Medicaid |
$174.39
|
| Rate for Payer: AlohaCare Medicare |
$174.39
|
| Rate for Payer: Cash Price |
$7,826.40
|
| Rate for Payer: Cash Price |
$7,826.40
|
| Rate for Payer: Devoted Health Medicare |
$191.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,391.80
|
| Rate for Payer: Health Management Network Commercial |
$11,087.40
|
| Rate for Payer: Humana Medicare |
$174.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,217.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,652.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.39
|
| Rate for Payer: MDX Hawaii PPO |
$12,652.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7,826.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.39
|
| Rate for Payer: University Health Alliance Commercial |
$9,507.77
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 55150020210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 71288060011
|
|
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
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00143928410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION [26226]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 71288060010
|
|
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
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687073609
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 35573042851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 35573042851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 35573042880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687073611
|
|
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
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687073609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687073611
|
|
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
|
|
