|
ROOKE BOOT BK PROTECTOR BK-406
|
Facility
|
OP
|
$977.00
|
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$488.50 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$742.52
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Devoted Health Medicare |
$820.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$742.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$742.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$742.52
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$742.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$742.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$742.52
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
ROOKE BOOT BK PROTECTOR BK-406
|
Facility
|
IP
|
$977.00
|
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBCUTANEOUS SYRINGE [182609]
|
Facility
|
IP
|
$11,528.00
|
|
|
Service Code
|
HCPCS J3590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9,798.80 |
| Max. Negotiated Rate |
$11,182.16 |
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Health Management Network Commercial |
$9,798.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,375.20
|
| Rate for Payer: MDX Hawaii PPO |
$11,182.16
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$25.08
|
| Rate for Payer: AlohaCare Medicare |
$25.84
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Devoted Health Medicare |
$27.72
|
| Rate for Payer: Devoted Health Medicare |
$28.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.30
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$25.08
|
| Rate for Payer: Humana Medicare |
$25.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.84
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.08
|
| Rate for Payer: University Health Alliance Commercial |
$24.05
|
| Rate for Payer: University Health Alliance Commercial |
$24.78
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Humana Medicare |
$72.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$72.20
|
| Rate for Payer: AlohaCare Medicare |
$25.84
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$28.56
|
| Rate for Payer: Devoted Health Medicare |
$79.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$25.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.20
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.20
|
| Rate for Payer: University Health Alliance Commercial |
$24.78
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
ROSEN CRVED WIRE GUIDE
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$72.20
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$79.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Humana Medicare |
$72.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.20
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.20
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
ROSEN CRVED WIRE GUIDE
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
|
|
ROSUVASTATIN 20 MG TABLET [35135]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 50268071015
|
|
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
|
|
|
ROSUVASTATIN 20 MG TABLET [35135]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50268071011
|
|
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
|
|
|
ROSUVASTATIN 20 MG TABLET [35135]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50268071015
|
|
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
|
|
|
ROSUVASTATIN 20 MG TABLET [35135]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 50268071011
|
|
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
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50268071115
|
|
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
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 50268071111
|
|
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
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 50268071115
|
|
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
|
|
|
ROSUVASTATIN 40 MG TABLET [35136]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50268071111
|
|
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
|
|
|
ROTATIONAL THROMBECTOMY 6FX65
|
Facility
|
OP
|
$6,710.00
|
|
|
Service Code
|
HCPCS C1724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,355.00 |
| Max. Negotiated Rate |
$6,508.70 |
| Rate for Payer: AlohaCare Medicaid |
$3,355.00
|
| Rate for Payer: AlohaCare Medicare |
$5,099.60
|
| Rate for Payer: Cash Price |
$4,026.00
|
| Rate for Payer: Devoted Health Medicare |
$5,636.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,099.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,374.50
|
| Rate for Payer: Health Management Network Commercial |
$5,703.50
|
| Rate for Payer: Humana Medicare |
$5,099.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,039.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,422.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,099.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,508.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,099.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,099.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,099.60
|
| Rate for Payer: University Health Alliance Commercial |
$4,890.92
|
|
|
ROTATIONAL THROMBECTOMY 6FX65
|
Facility
|
IP
|
$6,710.00
|
|
|
Service Code
|
HCPCS C1724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,703.50 |
| Max. Negotiated Rate |
$6,508.70 |
| Rate for Payer: Cash Price |
$4,026.00
|
| Rate for Payer: Health Management Network Commercial |
$5,703.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,039.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,508.70
|
|
|
ROTATIONAL THROMBECTOMY 7FX65
|
Facility
|
OP
|
$6,710.00
|
|
|
Service Code
|
HCPCS C1724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,355.00 |
| Max. Negotiated Rate |
$6,508.70 |
| Rate for Payer: AlohaCare Medicaid |
$3,355.00
|
| Rate for Payer: AlohaCare Medicare |
$5,099.60
|
| Rate for Payer: Cash Price |
$4,026.00
|
| Rate for Payer: Devoted Health Medicare |
$5,636.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,099.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,374.50
|
| Rate for Payer: Health Management Network Commercial |
$5,703.50
|
| Rate for Payer: Humana Medicare |
$5,099.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,039.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,422.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,099.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,508.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,099.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,099.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,099.60
|
| Rate for Payer: University Health Alliance Commercial |
$4,890.92
|
|
|
ROTATIONAL THROMBECTOMY 7FX65
|
Facility
|
IP
|
$6,710.00
|
|
|
Service Code
|
HCPCS C1724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,703.50 |
| Max. Negotiated Rate |
$6,508.70 |
| Rate for Payer: Cash Price |
$4,026.00
|
| Rate for Payer: Health Management Network Commercial |
$5,703.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,039.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,508.70
|
|
|
ROTICULATOR 30.2-0 GRY END GIA
|
Facility
|
IP
|
$698.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$593.30 |
| Max. Negotiated Rate |
$677.06 |
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Health Management Network Commercial |
$593.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$628.20
|
| Rate for Payer: MDX Hawaii PPO |
$677.06
|
|
|
ROTICULATOR 30.2-0 GRY END GIA
|
Facility
|
OP
|
$698.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$677.06 |
| Rate for Payer: AlohaCare Medicaid |
$349.00
|
| Rate for Payer: AlohaCare Medicare |
$530.48
|
| Rate for Payer: Cash Price |
$418.80
|
| Rate for Payer: Devoted Health Medicare |
$586.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$530.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$663.10
|
| Rate for Payer: Health Management Network Commercial |
$593.30
|
| Rate for Payer: Humana Medicare |
$530.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$628.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$355.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$530.48
|
| Rate for Payer: MDX Hawaii PPO |
$677.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$530.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$530.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$530.48
|
| Rate for Payer: University Health Alliance Commercial |
$508.77
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
NDC 50474080403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$66.12
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Devoted Health Medicare |
$73.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.65
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$66.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.12
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.12
|
| Rate for Payer: University Health Alliance Commercial |
$63.41
|
|
|
ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
NDC 50474080403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
