|
GEL SIZER 350CC GS10512-350MP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 410CC GS10512-410MP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 410CC GS10512-410MP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 525CC GS10621-525MP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 525CC GS10621-525MP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 565CC GS10621-565HP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 565CC GS10621-565HP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 575CC GS10621-575MP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 575CC GS10621-575MP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 695CC GS10621-695MP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER 695CC GS10621-695MP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER GS10621-505HP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER GS10621-505HP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-385HP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-385HP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-415HP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-415HP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-440HP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-440HP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-470HP
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.64 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL SIZER RND GS10621-470HP
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.00 |
| Max. Negotiated Rate |
$818.68 |
| Rate for Payer: AlohaCare Medicaid |
$422.00
|
| Rate for Payer: AlohaCare Medicare |
$641.44
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Devoted Health Medicare |
$708.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.80
|
| Rate for Payer: Health Management Network Commercial |
$717.40
|
| Rate for Payer: Humana Medicare |
$641.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$430.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.44
|
| Rate for Payer: MDX Hawaii PPO |
$818.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$641.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.44
|
| Rate for Payer: University Health Alliance Commercial |
$472.64
|
|
|
GEL THERAHONEY WOUND GEL 1.5
|
Facility
|
OP
|
$66.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: AlohaCare Medicaid |
$33.00
|
| Rate for Payer: AlohaCare Medicare |
$50.16
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$55.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.70
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Humana Medicare |
$50.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.16
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.16
|
| Rate for Payer: University Health Alliance Commercial |
$48.11
|
|
|
GEL THERAHONEY WOUND GEL 1.5
|
Facility
|
IP
|
$66.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.40
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [151139]
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS J9196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: AlohaCare Medicaid |
$132.00
|
| Rate for Payer: AlohaCare Medicaid |
$148.50
|
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicaid |
$211.50
|
| Rate for Payer: AlohaCare Medicare |
$321.48
|
| Rate for Payer: AlohaCare Medicare |
$180.88
|
| Rate for Payer: AlohaCare Medicare |
$200.64
|
| Rate for Payer: AlohaCare Medicare |
$225.72
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Devoted Health Medicare |
$249.48
|
| Rate for Payer: Devoted Health Medicare |
$221.76
|
| Rate for Payer: Devoted Health Medicare |
$355.32
|
| Rate for Payer: Devoted Health Medicare |
$199.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$321.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$282.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$226.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: Humana Medicare |
$180.88
|
| Rate for Payer: Humana Medicare |
$225.72
|
| Rate for Payer: Humana Medicare |
$200.64
|
| Rate for Payer: Humana Medicare |
$321.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$380.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$321.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.64
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$321.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$321.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$158.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$253.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$321.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.64
|
| Rate for Payer: University Health Alliance Commercial |
$173.48
|
| Rate for Payer: University Health Alliance Commercial |
$192.43
|
| Rate for Payer: University Health Alliance Commercial |
$216.48
|
| Rate for Payer: University Health Alliance Commercial |
$308.32
|
|
|
GEMCITABINE 100 MG/ML INTRAVENOUS SOLUTION [151139]
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS J9196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$380.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
|
