|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$15,714.43
|
|
|
Service Code
|
MSDRG 918
|
| Min. Negotiated Rate |
$15,714.43 |
| Max. Negotiated Rate |
$15,714.43 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,714.43
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG/7ML IV (WET SOLR VIAL) [430168184]
|
Facility
|
IP
|
$22,834.00
|
|
|
Service Code
|
HCPCS J9309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19,408.90 |
| Max. Negotiated Rate |
$22,148.98 |
| Rate for Payer: Cash Price |
$13,700.40
|
| Rate for Payer: Health Management Network Commercial |
$19,408.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$20,550.60
|
| Rate for Payer: MDX Hawaii PPO |
$22,148.98
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG/7ML IV (WET SOLR VIAL) [430168184]
|
Facility
|
OP
|
$22,834.00
|
|
|
Service Code
|
HCPCS J9309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$22,148.98 |
| Rate for Payer: AlohaCare Medicaid |
$11,417.00
|
| Rate for Payer: AlohaCare Medicare |
$17,353.84
|
| Rate for Payer: Cash Price |
$13,700.40
|
| Rate for Payer: Cash Price |
$13,700.40
|
| Rate for Payer: Devoted Health Medicare |
$19,180.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17,353.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21,692.30
|
| Rate for Payer: Health Management Network Commercial |
$19,408.90
|
| Rate for Payer: Humana Medicare |
$17,353.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$20,550.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11,645.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$17,353.84
|
| Rate for Payer: MDX Hawaii PPO |
$22,148.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17,353.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$17,353.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13,700.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$17,353.84
|
| Rate for Payer: University Health Alliance Commercial |
$16,643.70
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [168184]
|
Facility
|
OP
|
$12,848.00
|
|
|
Service Code
|
HCPCS J9309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$12,462.56 |
| Rate for Payer: AlohaCare Medicaid |
$6,424.00
|
| Rate for Payer: AlohaCare Medicaid |
$11,417.00
|
| Rate for Payer: AlohaCare Medicare |
$17,353.84
|
| Rate for Payer: AlohaCare Medicare |
$9,764.48
|
| Rate for Payer: Cash Price |
$7,708.80
|
| Rate for Payer: Cash Price |
$7,708.80
|
| Rate for Payer: Cash Price |
$13,700.40
|
| Rate for Payer: Cash Price |
$13,700.40
|
| Rate for Payer: Devoted Health Medicare |
$10,792.32
|
| Rate for Payer: Devoted Health Medicare |
$19,180.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,764.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17,353.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,205.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21,692.30
|
| Rate for Payer: Health Management Network Commercial |
$10,920.80
|
| Rate for Payer: Health Management Network Commercial |
$19,408.90
|
| Rate for Payer: Humana Medicare |
$9,764.48
|
| Rate for Payer: Humana Medicare |
$17,353.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,563.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$20,550.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,552.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11,645.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,764.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$17,353.84
|
| Rate for Payer: MDX Hawaii PPO |
$12,462.56
|
| Rate for Payer: MDX Hawaii PPO |
$22,148.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17,353.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,764.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,764.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$17,353.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7,708.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13,700.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$17,353.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,764.48
|
| Rate for Payer: University Health Alliance Commercial |
$9,364.91
|
| Rate for Payer: University Health Alliance Commercial |
$16,643.70
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION [168184]
|
Facility
|
IP
|
$12,848.00
|
|
|
Service Code
|
HCPCS J9309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,920.80 |
| Max. Negotiated Rate |
$12,462.56 |
| Rate for Payer: Cash Price |
$7,708.80
|
| Rate for Payer: Cash Price |
$13,700.40
|
| Rate for Payer: Health Management Network Commercial |
$19,408.90
|
| Rate for Payer: Health Management Network Commercial |
$10,920.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,563.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$20,550.60
|
| Rate for Payer: MDX Hawaii PPO |
$12,462.56
|
| Rate for Payer: MDX Hawaii PPO |
$22,148.98
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION [174859]
|
Facility
|
IP
|
$5,286.00
|
|
|
Service Code
|
HCPCS J9309
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,493.10 |
| Max. Negotiated Rate |
$5,127.42 |
| Rate for Payer: Cash Price |
$3,171.60
|
| Rate for Payer: Health Management Network Commercial |
$4,493.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,757.40
|
| Rate for Payer: MDX Hawaii PPO |
$5,127.42
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION [174859]
|
Facility
|
OP
|
$5,286.00
|
|
|
Service Code
|
HCPCS J9309
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$5,127.42 |
| Rate for Payer: AlohaCare Medicaid |
$2,643.00
|
| Rate for Payer: AlohaCare Medicare |
$4,017.36
|
| Rate for Payer: Cash Price |
$3,171.60
|
| Rate for Payer: Cash Price |
$3,171.60
|
| Rate for Payer: Devoted Health Medicare |
$4,440.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$171.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,017.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,021.70
|
| Rate for Payer: Health Management Network Commercial |
$4,493.10
|
| Rate for Payer: Humana Medicare |
$4,017.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,757.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,695.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,017.36
|
| Rate for Payer: MDX Hawaii PPO |
$5,127.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,017.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,017.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,171.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,017.36
|
| Rate for Payer: University Health Alliance Commercial |
$3,852.97
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 62559015730
|
|
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
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 00904693176
|
|
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
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00904693176
|
|
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
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00904693186
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 62559015730
|
|
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
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 00904693186
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.80
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.80
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
PORT ACCESS AIRSEAL 8X100MM
|
Facility
|
IP
|
$351.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
|
|
PORT ACCESS AIRSEAL 8X100MM
|
Facility
|
OP
|
$351.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: AlohaCare Medicaid |
$175.50
|
| Rate for Payer: AlohaCare Medicare |
$266.76
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Devoted Health Medicare |
$294.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Humana Medicare |
$266.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.76
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.76
|
| Rate for Payer: University Health Alliance Commercial |
$255.84
|
|
|
PORTAL SKID AR-4505
|
Facility
|
OP
|
$236.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$228.92 |
| 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: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
PORTAL SKID AR-4505
|
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
|
|
|
PORT INTERGRATED ALLOX2-FH11SE
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$3,637.50 |
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,625.00
|
| Rate for Payer: Health Management Network Commercial |
$3,187.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,375.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,637.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,100.00
|
|
|
PORT INTERGRATED ALLOX2-FH11SE
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,637.50 |
| Rate for Payer: Kaiser Permanente Medicaid |
$1,912.50
|
| Rate for Payer: AlohaCare Medicaid |
$1,875.00
|
| Rate for Payer: AlohaCare Medicare |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Devoted Health Medicare |
$3,150.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,850.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,625.00
|
| Rate for Payer: Health Management Network Commercial |
$3,187.50
|
| Rate for Payer: Humana Medicare |
$2,850.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,375.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,850.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,637.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,850.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,850.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,850.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,100.00
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [125429]
|
Facility
|
IP
|
$1,592.00
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,353.20 |
| Max. Negotiated Rate |
$1,544.24 |
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Health Management Network Commercial |
$1,353.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,432.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,544.24
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [125429]
|
Facility
|
OP
|
$1,592.00
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$796.00 |
| Max. Negotiated Rate |
$1,544.24 |
| Rate for Payer: AlohaCare Medicaid |
$796.00
|
| Rate for Payer: AlohaCare Medicare |
$1,209.92
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Devoted Health Medicare |
$1,337.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,209.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,512.40
|
| Rate for Payer: Health Management Network Commercial |
$1,353.20
|
| Rate for Payer: Humana Medicare |
$1,209.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,432.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$811.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,209.92
|
| Rate for Payer: MDX Hawaii PPO |
$1,544.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,209.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$955.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,209.92
|
| Rate for Payer: University Health Alliance Commercial |
$1,160.41
|
|
|
POSITIONER SAFE-T
|
Facility
|
OP
|
$544.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: AlohaCare Medicaid |
$272.00
|
| Rate for Payer: AlohaCare Medicare |
$413.44
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Devoted Health Medicare |
$456.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$413.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.80
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Humana Medicare |
$413.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$413.44
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$413.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$413.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$413.44
|
| Rate for Payer: University Health Alliance Commercial |
$396.52
|
|
|
POSITIONER SAFE-T
|
Facility
|
IP
|
$544.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
|
|
POSITIONING REVERSE KIT 40642
|
Facility
|
OP
|
$737.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.50 |
| Max. Negotiated Rate |
$714.89 |
| Rate for Payer: AlohaCare Medicaid |
$368.50
|
| Rate for Payer: AlohaCare Medicare |
$560.12
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Devoted Health Medicare |
$619.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$560.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$700.15
|
| Rate for Payer: Health Management Network Commercial |
$626.45
|
| Rate for Payer: Humana Medicare |
$560.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$663.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$375.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$560.12
|
| Rate for Payer: MDX Hawaii PPO |
$714.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$560.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$560.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$560.12
|
| Rate for Payer: University Health Alliance Commercial |
$537.20
|
|
|
POSITIONING REVERSE KIT 40642
|
Facility
|
IP
|
$737.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$626.45 |
| Max. Negotiated Rate |
$714.89 |
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Health Management Network Commercial |
$626.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$663.30
|
| Rate for Payer: MDX Hawaii PPO |
$714.89
|
|
