|
CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [162615]
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.09 |
| Max. Negotiated Rate |
$1,030.14 |
| Rate for Payer: AlohaCare Medicaid |
$56.24
|
| Rate for Payer: AlohaCare Medicare |
$56.24
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Devoted Health Medicare |
$61.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,008.90
|
| Rate for Payer: Health Management Network Commercial |
$902.70
|
| Rate for Payer: Humana Medicare |
$56.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$669.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$541.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,030.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$637.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.24
|
| Rate for Payer: University Health Alliance Commercial |
$774.09
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [132744]
|
Facility
|
OP
|
$2,623.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.09 |
| Max. Negotiated Rate |
$2,544.31 |
| Rate for Payer: AlohaCare Medicaid |
$56.24
|
| Rate for Payer: AlohaCare Medicare |
$56.24
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Devoted Health Medicare |
$61.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,491.85
|
| Rate for Payer: Health Management Network Commercial |
$2,229.55
|
| Rate for Payer: Humana Medicare |
$56.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,652.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,337.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.24
|
| Rate for Payer: MDX Hawaii PPO |
$2,544.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,573.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,911.90
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [132744]
|
Facility
|
IP
|
$2,623.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,229.55 |
| Max. Negotiated Rate |
$2,544.31 |
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Health Management Network Commercial |
$2,229.55
|
| Rate for Payer: MDX Hawaii PPO |
$2,544.31
|
|
|
CARFILZOMIB 60 MG/30ML IV (WET SOLR VIAL) [430117047]
|
Facility
|
IP
|
$4,745.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,033.25 |
| Max. Negotiated Rate |
$4,602.65 |
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Health Management Network Commercial |
$4,033.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,602.65
|
|
|
CARFILZOMIB 60 MG/30ML IV (WET SOLR VIAL) [430117047]
|
Facility
|
OP
|
$4,745.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.09 |
| Max. Negotiated Rate |
$4,602.65 |
| Rate for Payer: AlohaCare Medicaid |
$56.24
|
| Rate for Payer: AlohaCare Medicare |
$56.24
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Devoted Health Medicare |
$61.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,507.75
|
| Rate for Payer: Health Management Network Commercial |
$4,033.25
|
| Rate for Payer: Humana Medicare |
$56.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,989.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,419.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.24
|
| Rate for Payer: MDX Hawaii PPO |
$4,602.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,847.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,458.63
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [117047]
|
Facility
|
OP
|
$4,745.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.09 |
| Max. Negotiated Rate |
$4,602.65 |
| Rate for Payer: AlohaCare Medicaid |
$56.24
|
| Rate for Payer: AlohaCare Medicaid |
$56.24
|
| Rate for Payer: AlohaCare Medicare |
$56.24
|
| Rate for Payer: AlohaCare Medicare |
$56.24
|
| Rate for Payer: Cash Price |
$1,242.60
|
| Rate for Payer: Cash Price |
$1,242.60
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Devoted Health Medicare |
$61.86
|
| Rate for Payer: Devoted Health Medicare |
$61.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,967.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,507.75
|
| Rate for Payer: Health Management Network Commercial |
$1,760.35
|
| Rate for Payer: Health Management Network Commercial |
$4,033.25
|
| Rate for Payer: Humana Medicare |
$56.24
|
| Rate for Payer: Humana Medicare |
$56.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,304.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,989.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,419.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,056.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.24
|
| Rate for Payer: MDX Hawaii PPO |
$2,008.87
|
| Rate for Payer: MDX Hawaii PPO |
$4,602.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,847.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,242.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,509.55
|
| Rate for Payer: University Health Alliance Commercial |
$3,458.63
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [117047]
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS J9047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,760.35 |
| Max. Negotiated Rate |
$2,008.87 |
| Rate for Payer: Cash Price |
$1,242.60
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Health Management Network Commercial |
$4,033.25
|
| Rate for Payer: Health Management Network Commercial |
$1,760.35
|
| Rate for Payer: MDX Hawaii PPO |
$2,008.87
|
| Rate for Payer: MDX Hawaii PPO |
$4,602.65
|
|
|
CARIPRAZINE 1.5 MG CAPSULE [131293]
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 61874011520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
CARIPRAZINE 1.5 MG CAPSULE [131293]
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
NDC 61874011520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.22 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.90
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: University Health Alliance Commercial |
$88.93
|
|
|
CARIPRAZINE 1.5 MG CAPSULE [131293]
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 61874011530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
CARIPRAZINE 1.5 MG CAPSULE [131293]
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
NDC 61874011530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.22 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.90
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: University Health Alliance Commercial |
$88.93
|
|
|
CARIPRAZINE 3 MG CAPSULE [131294]
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 61874013020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
CARIPRAZINE 3 MG CAPSULE [131294]
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
NDC 61874013011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.22 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.90
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: University Health Alliance Commercial |
$88.93
|
|
|
CARIPRAZINE 3 MG CAPSULE [131294]
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
NDC 61874013011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
CARIPRAZINE 3 MG CAPSULE [131294]
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
NDC 61874013020
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.22 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.90
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: University Health Alliance Commercial |
$88.93
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$41,236.12
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$41,236.12 |
| Rate for Payer: AlohaCare Medicare |
$27,190.16
|
| Rate for Payer: Devoted Health Medicare |
$29,909.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27,190.16
|
| Rate for Payer: Humana Medicare |
$27,190.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$41,236.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$27,190.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$27,190.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$27,190.16
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$66,769.57
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$66,769.57 |
| Rate for Payer: AlohaCare Medicare |
$44,026.34
|
| Rate for Payer: Devoted Health Medicare |
$48,428.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44,026.34
|
| Rate for Payer: Humana Medicare |
$44,026.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$66,769.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$44,026.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$44,026.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$44,026.34
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,513.30
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$33,513.30 |
| Rate for Payer: AlohaCare Medicare |
$22,097.90
|
| Rate for Payer: Devoted Health Medicare |
$24,307.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22,097.90
|
| Rate for Payer: Humana Medicare |
$22,097.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$33,513.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$22,097.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$22,097.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$22,097.90
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904730761
|
|
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
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 72888003601
|
|
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
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 00904630261
|
|
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
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 00904630261
|
|
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
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 72888003601
|
|
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
|
|
|
CARVEDILOL 12.5 MG TABLET [15749]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904730761
|
|
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
|
|
|
CARVEDILOL 25 MG TABLET [15748]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904730861
|
|
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
|
|
