|
NAIL TI END CAP 04.004.002S
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$1,096.10 |
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$791.00
|
| Rate for Payer: Health Management Network Commercial |
$960.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,017.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,096.10
|
| Rate for Payer: University Health Alliance Commercial |
$632.80
|
|
|
NAIL TI END CAP 04.004.002S
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$1,096.10 |
| Rate for Payer: AlohaCare Medicaid |
$565.00
|
| Rate for Payer: AlohaCare Medicare |
$858.80
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Devoted Health Medicare |
$949.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$858.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$791.00
|
| Rate for Payer: Health Management Network Commercial |
$960.50
|
| Rate for Payer: Humana Medicare |
$858.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,017.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$576.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$858.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,096.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$858.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$858.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$858.80
|
| Rate for Payer: University Health Alliance Commercial |
$632.80
|
|
|
NAIL TRCH 3 GMA 3125-0170S
|
Facility
|
OP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.00 |
| Max. Negotiated Rate |
$4,588.10 |
| Rate for Payer: AlohaCare Medicaid |
$2,365.00
|
| Rate for Payer: AlohaCare Medicare |
$3,594.80
|
| Rate for Payer: Cash Price |
$2,838.00
|
| Rate for Payer: Devoted Health Medicare |
$3,973.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,594.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,311.00
|
| Rate for Payer: Health Management Network Commercial |
$4,020.50
|
| Rate for Payer: Humana Medicare |
$3,594.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,257.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,412.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,594.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,588.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,594.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,594.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,594.80
|
| Rate for Payer: University Health Alliance Commercial |
$2,648.80
|
|
|
NAIL TRCH 3 GMA 3125-0170S
|
Facility
|
IP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,648.80 |
| Max. Negotiated Rate |
$4,588.10 |
| Rate for Payer: Cash Price |
$2,838.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,311.00
|
| Rate for Payer: Health Management Network Commercial |
$4,020.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,257.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,588.10
|
| Rate for Payer: University Health Alliance Commercial |
$2,648.80
|
|
|
NAIL TROCH 10X320 8425-0320S
|
Facility
|
OP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,546.00 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: AlohaCare Medicaid |
$3,546.00
|
| Rate for Payer: AlohaCare Medicare |
$5,389.92
|
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Devoted Health Medicare |
$5,957.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,389.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Humana Medicare |
$5,389.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,616.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,389.92
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,389.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,389.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,389.92
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL TROCH 10X320 8425-0320S
|
Facility
|
IP
|
$7,092.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,971.52 |
| Max. Negotiated Rate |
$6,879.24 |
| Rate for Payer: Cash Price |
$4,255.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,964.40
|
| Rate for Payer: Health Management Network Commercial |
$6,028.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,382.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,879.24
|
| Rate for Payer: University Health Alliance Commercial |
$3,971.52
|
|
|
NAIL TROCH 11X170 8125-1170S
|
Facility
|
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.50 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,390.50
|
| Rate for Payer: AlohaCare Medicare |
$3,633.56
|
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Devoted Health Medicare |
$4,016.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,633.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Humana Medicare |
$3,633.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,438.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,633.56
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,633.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,633.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,633.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL TROCH 11X170 8125-1170S
|
Facility
|
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.36 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL TROCHANTERIC 8130-0170S
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$5,090.56 |
| Rate for Payer: AlohaCare Medicaid |
$2,624.00
|
| Rate for Payer: AlohaCare Medicare |
$3,988.48
|
| Rate for Payer: Cash Price |
$3,148.80
|
| Rate for Payer: Devoted Health Medicare |
$4,408.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,988.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,673.60
|
| Rate for Payer: Health Management Network Commercial |
$4,460.80
|
| Rate for Payer: Humana Medicare |
$3,988.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,723.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,676.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,988.48
|
| Rate for Payer: MDX Hawaii PPO |
$5,090.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,988.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,988.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,988.48
|
| Rate for Payer: University Health Alliance Commercial |
$2,938.88
|
|
|
NAIL TROCHANTERIC 8130-0170S
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,938.88 |
| Max. Negotiated Rate |
$5,090.56 |
| Rate for Payer: Cash Price |
$3,148.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,673.60
|
| Rate for Payer: Health Management Network Commercial |
$4,460.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,723.20
|
| Rate for Payer: MDX Hawaii PPO |
$5,090.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,938.88
|
|
|
NAIL TROCHANTERIC 8130-1170S
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,938.88 |
| Max. Negotiated Rate |
$5,090.56 |
| Rate for Payer: Cash Price |
$3,148.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,673.60
|
| Rate for Payer: Health Management Network Commercial |
$4,460.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,723.20
|
| Rate for Payer: MDX Hawaii PPO |
$5,090.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,938.88
|
|
|
NAIL TROCHANTERIC 8130-1170S
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$5,090.56 |
| Rate for Payer: AlohaCare Medicaid |
$2,624.00
|
| Rate for Payer: AlohaCare Medicare |
$3,988.48
|
| Rate for Payer: Cash Price |
$3,148.80
|
| Rate for Payer: Devoted Health Medicare |
$4,408.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,988.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,673.60
|
| Rate for Payer: Health Management Network Commercial |
$4,460.80
|
| Rate for Payer: Humana Medicare |
$3,988.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,723.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,676.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,988.48
|
| Rate for Payer: MDX Hawaii PPO |
$5,090.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,988.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,988.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,988.48
|
| Rate for Payer: University Health Alliance Commercial |
$2,938.88
|
|
|
NAIL TROCHANTERIC 8130-2170S
|
Facility
|
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.36 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL TROCHANTERIC 8130-2170S
|
Facility
|
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.50 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,390.50
|
| Rate for Payer: AlohaCare Medicare |
$3,633.56
|
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Devoted Health Medicare |
$4,016.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,633.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Humana Medicare |
$3,633.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,438.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,633.56
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,633.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,633.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,633.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL TROCHANTERIC 8130-3170S
|
Facility
|
IP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.36 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAIL TROCHANTERIC 8130-3170S
|
Facility
|
OP
|
$4,781.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,390.50 |
| Max. Negotiated Rate |
$4,637.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,390.50
|
| Rate for Payer: AlohaCare Medicare |
$3,633.56
|
| Rate for Payer: Cash Price |
$2,868.60
|
| Rate for Payer: Devoted Health Medicare |
$4,016.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,633.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,346.70
|
| Rate for Payer: Health Management Network Commercial |
$4,063.85
|
| Rate for Payer: Humana Medicare |
$3,633.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,302.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,438.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,633.56
|
| Rate for Payer: MDX Hawaii PPO |
$4,637.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,633.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,633.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,633.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.36
|
|
|
NAI TI 10X400/RT 04.003.360S
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.00 |
| Max. Negotiated Rate |
$4,171.00 |
| Rate for Payer: AlohaCare Medicaid |
$2,150.00
|
| Rate for Payer: AlohaCare Medicare |
$3,268.00
|
| Rate for Payer: Cash Price |
$2,580.00
|
| Rate for Payer: Devoted Health Medicare |
$3,612.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,268.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,010.00
|
| Rate for Payer: Health Management Network Commercial |
$3,655.00
|
| Rate for Payer: Humana Medicare |
$3,268.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,870.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,193.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,268.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,171.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,268.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,268.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,268.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,408.00
|
|
|
NAI TI 10X400/RT 04.003.360S
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,408.00 |
| Max. Negotiated Rate |
$4,171.00 |
| Rate for Payer: Cash Price |
$2,580.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,010.00
|
| Rate for Payer: Health Management Network Commercial |
$3,655.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,870.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,171.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,408.00
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS J2300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION [5339]
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J2300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$12.16
|
| Rate for Payer: AlohaCare Medicare |
$9.12
|
| Rate for Payer: AlohaCare Medicare |
$14.44
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$10.08
|
| Rate for Payer: Devoted Health Medicare |
$15.96
|
| Rate for Payer: Devoted Health Medicare |
$13.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$9.12
|
| Rate for Payer: Humana Medicare |
$12.16
|
| Rate for Payer: Humana Medicare |
$14.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.44
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.44
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
NALOXONE 0.4 MG/10 ML (40 MCG/ML) DILUTE INJ (RN PREP) [401284]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$45.60
|
| Rate for Payer: AlohaCare Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$15.12
|
| Rate for Payer: Devoted Health Medicare |
$50.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: Humana Medicare |
$45.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.60
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.60
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
NALOXONE 0.4 MG/10 ML (40 MCG/ML) DILUTE INJ (RN PREP) [401284]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
NALOXONE 0.4 MG/ML INJECTION SOLUTION [5373]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$45.60
|
| Rate for Payer: AlohaCare Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$15.12
|
| Rate for Payer: Devoted Health Medicare |
$50.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: Humana Medicare |
$45.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.60
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.60
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
NALOXONE 1 MG/ML INJECTION SYRINGE [134075]
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS J2312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
