|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS J1805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$481.95 |
| Max. Negotiated Rate |
$549.99 |
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Health Management Network Commercial |
$481.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$510.30
|
| Rate for Payer: MDX Hawaii PPO |
$549.99
|
|
|
ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV [29805]
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS J1805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$549.99 |
| Rate for Payer: AlohaCare Medicaid |
$283.50
|
| Rate for Payer: AlohaCare Medicare |
$430.92
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Devoted Health Medicare |
$476.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$430.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$538.65
|
| Rate for Payer: Health Management Network Commercial |
$481.95
|
| Rate for Payer: Humana Medicare |
$430.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$510.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$289.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.92
|
| Rate for Payer: MDX Hawaii PPO |
$549.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$430.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$430.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$430.92
|
| Rate for Payer: University Health Alliance Commercial |
$413.29
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$16,923.23
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$16,923.23 |
| Max. Negotiated Rate |
$16,923.23 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16,923.23
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,553.03
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$14,553.03 |
| Max. Negotiated Rate |
$14,553.03 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,553.03
|
|
|
ESOPH BALLN 5.5FRX10-20MM
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: AlohaCare Medicaid |
$412.50
|
| Rate for Payer: AlohaCare Medicare |
$627.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Devoted Health Medicare |
$693.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$627.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$783.75
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Humana Medicare |
$627.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$420.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$627.00
|
| Rate for Payer: MDX Hawaii PPO |
$800.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$627.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$627.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$627.00
|
| Rate for Payer: University Health Alliance Commercial |
$601.34
|
|
|
ESOPH BALLN 5.5FRX10-20MM
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1726
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.25 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.50
|
| Rate for Payer: MDX Hawaii PPO |
$800.25
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL [2929]
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS J1000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$572.30 |
| Rate for Payer: AlohaCare Medicaid |
$295.00
|
| Rate for Payer: AlohaCare Medicare |
$448.40
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Devoted Health Medicare |
$495.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$448.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.50
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Humana Medicare |
$448.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$448.40
|
| Rate for Payer: MDX Hawaii PPO |
$572.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$448.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$448.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$448.40
|
| Rate for Payer: University Health Alliance Commercial |
$430.05
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL [2929]
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS J1000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$572.30 |
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.00
|
| Rate for Payer: MDX Hawaii PPO |
$572.30
|
|
|
ETHAMBUTOL 100 MG TABLET [9982]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68180028001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$2.28
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$2.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.28
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.28
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ETHAMBUTOL 100 MG TABLET [9982]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68180028001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| 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
|
|
|
ETHAMBUTOL 400 MG TABLET [9983]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68180028101
|
|
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: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
|
ETHAMBUTOL 400 MG TABLET [9983]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 68180028101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: AlohaCare Medicaid |
$3.50
|
| Rate for Payer: AlohaCare Medicare |
$5.32
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$5.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.32
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.32
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
ETHAMBUTOL 400 MG TABLET [9983]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084028001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$4.56
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$5.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$4.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.56
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.56
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
ETHAMBUTOL 400 MG TABLET [9983]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084028001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
ETHICON PROLENE HERNIA PHSE
|
Facility
|
OP
|
$2,016.00
|
|
|
Service Code
|
HCPCS C1781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$1,955.52 |
| Rate for Payer: AlohaCare Medicaid |
$1,008.00
|
| Rate for Payer: AlohaCare Medicare |
$1,532.16
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Devoted Health Medicare |
$1,693.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,532.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,411.20
|
| Rate for Payer: Health Management Network Commercial |
$1,713.60
|
| Rate for Payer: Humana Medicare |
$1,532.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,814.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,028.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,532.16
|
| Rate for Payer: MDX Hawaii PPO |
$1,955.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,532.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,532.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,532.16
|
| Rate for Payer: University Health Alliance Commercial |
$1,128.96
|
|
|
ETHICON PROLENE HERNIA PHSE
|
Facility
|
IP
|
$2,016.00
|
|
|
Service Code
|
HCPCS C1781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.96 |
| Max. Negotiated Rate |
$1,955.52 |
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,411.20
|
| Rate for Payer: Health Management Network Commercial |
$1,713.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,814.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,955.52
|
| Rate for Payer: University Health Alliance Commercial |
$1,128.96
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 72266014610
|
|
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: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 00143950610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
NDC 00143950601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
HCPCS J7307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,664.30 |
| Max. Negotiated Rate |
$1,899.26 |
| Rate for Payer: Cash Price |
$1,174.80
|
| Rate for Payer: Health Management Network Commercial |
$1,664.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,762.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,899.26
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [122196]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J9181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Health Management Network Commercial |
$338.30
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$358.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$386.06
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [122196]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J9181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicaid |
$99.50
|
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicaid |
$199.00
|
| Rate for Payer: AlohaCare Medicare |
$22.80
|
| Rate for Payer: AlohaCare Medicare |
$302.48
|
| Rate for Payer: AlohaCare Medicare |
$121.60
|
| Rate for Payer: AlohaCare Medicare |
$30.40
|
| Rate for Payer: AlohaCare Medicare |
$151.24
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Devoted Health Medicare |
$334.32
|
| Rate for Payer: Devoted Health Medicare |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$167.16
|
| Rate for Payer: Devoted Health Medicare |
$134.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$151.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$302.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$189.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$378.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.00
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Health Management Network Commercial |
$338.30
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Humana Medicare |
$151.24
|
| Rate for Payer: Humana Medicare |
$121.60
|
| Rate for Payer: Humana Medicare |
$302.48
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$358.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.40
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: MDX Hawaii PPO |
$386.06
|
| Rate for Payer: MDX Hawaii PPO |
$193.03
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$302.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$302.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$238.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$302.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.80
|
| Rate for Payer: University Health Alliance Commercial |
$116.62
|
| Rate for Payer: University Health Alliance Commercial |
$21.87
|
| Rate for Payer: University Health Alliance Commercial |
$290.10
|
| Rate for Payer: University Health Alliance Commercial |
$145.05
|
| Rate for Payer: University Health Alliance Commercial |
$29.16
|
|
|
EXCALIBUR 5.5MM AR-8550EX
|
Facility
|
IP
|
$236.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
EXCALIBUR 5.5MM AR-8550EX
|
Facility
|
OP
|
$236.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$179.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$198.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$179.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.36
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
EXCLUDER 14.5/10CM PLC141000
|
Facility
|
IP
|
$11,204.00
|
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,274.24 |
| Max. Negotiated Rate |
$10,867.88 |
| Rate for Payer: Cash Price |
$6,722.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,842.80
|
| Rate for Payer: Health Management Network Commercial |
$9,523.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,083.60
|
| Rate for Payer: MDX Hawaii PPO |
$10,867.88
|
| Rate for Payer: University Health Alliance Commercial |
$6,274.24
|
|
