|
DRILL 2.0 703896
|
Facility
|
OP
|
$648.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.88 |
| Max. Negotiated Rate |
$628.56 |
| Rate for Payer: AlohaCare Medicaid |
$324.00
|
| Rate for Payer: AlohaCare Medicare |
$200.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Devoted Health Medicare |
$220.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$615.60
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Humana Medicare |
$200.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.88
|
| Rate for Payer: MDX Hawaii PPO |
$628.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.88
|
| Rate for Payer: University Health Alliance Commercial |
$472.33
|
|
|
DRILL 2.0MM SHORT PILOT DRILL
|
Facility
|
OP
|
$1,005.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$311.55 |
| Max. Negotiated Rate |
$974.85 |
| Rate for Payer: AlohaCare Medicaid |
$502.50
|
| Rate for Payer: AlohaCare Medicare |
$311.55
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Devoted Health Medicare |
$341.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$311.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$954.75
|
| Rate for Payer: Health Management Network Commercial |
$854.25
|
| Rate for Payer: Humana Medicare |
$311.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$904.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$512.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$311.55
|
| Rate for Payer: MDX Hawaii PPO |
$974.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$311.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$311.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$311.55
|
| Rate for Payer: University Health Alliance Commercial |
$732.54
|
|
|
DRILL 2.0MM SHORT PILOT DRILL
|
Facility
|
IP
|
$1,005.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$854.25 |
| Max. Negotiated Rate |
$974.85 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Health Management Network Commercial |
$854.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$904.50
|
| Rate for Payer: MDX Hawaii PPO |
$974.85
|
|
|
DRILL 2.1 100MM CANN SMTH
|
Facility
|
OP
|
$825.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: AlohaCare Medicaid |
$412.50
|
| Rate for Payer: AlohaCare Medicare |
$255.75
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Devoted Health Medicare |
$280.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$783.75
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Humana Medicare |
$255.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$420.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.75
|
| Rate for Payer: MDX Hawaii PPO |
$800.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.75
|
| Rate for Payer: University Health Alliance Commercial |
$601.34
|
|
|
DRILL 2.1 100MM CANN SMTH
|
Facility
|
IP
|
$825.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.25 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.50
|
| Rate for Payer: MDX Hawaii PPO |
$800.25
|
|
|
DRILL 2.1X110MM DRILL-2.1/110C
|
Facility
|
OP
|
$825.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: AlohaCare Medicaid |
$412.50
|
| Rate for Payer: AlohaCare Medicare |
$255.75
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Devoted Health Medicare |
$280.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$783.75
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Humana Medicare |
$255.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$420.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.75
|
| Rate for Payer: MDX Hawaii PPO |
$800.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.75
|
| Rate for Payer: University Health Alliance Commercial |
$601.34
|
|
|
DRILL 2.1X110MM DRILL-2.1/110C
|
Facility
|
IP
|
$825.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.25 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$742.50
|
| Rate for Payer: MDX Hawaii PPO |
$800.25
|
|
|
DRILL 2351-4213S
|
Facility
|
OP
|
$823.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.13 |
| Max. Negotiated Rate |
$798.31 |
| Rate for Payer: AlohaCare Medicaid |
$411.50
|
| Rate for Payer: AlohaCare Medicare |
$255.13
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Devoted Health Medicare |
$279.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$781.85
|
| Rate for Payer: Health Management Network Commercial |
$699.55
|
| Rate for Payer: Humana Medicare |
$255.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$419.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.13
|
| Rate for Payer: MDX Hawaii PPO |
$798.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.13
|
| Rate for Payer: University Health Alliance Commercial |
$599.88
|
|
|
DRILL 2351-4213S
|
Facility
|
IP
|
$823.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.55 |
| Max. Negotiated Rate |
$798.31 |
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Health Management Network Commercial |
$699.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.70
|
| Rate for Payer: MDX Hawaii PPO |
$798.31
|
|
|
DRILL 2.3 CANN MANUAL 316-0005
|
Facility
|
IP
|
$879.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.15 |
| Max. Negotiated Rate |
$852.63 |
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.10
|
| Rate for Payer: MDX Hawaii PPO |
$852.63
|
|
|
DRILL 2.3 CANN MANUAL 316-0005
|
Facility
|
OP
|
$879.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.49 |
| Max. Negotiated Rate |
$852.63 |
| Rate for Payer: AlohaCare Medicaid |
$439.50
|
| Rate for Payer: AlohaCare Medicare |
$272.49
|
| Rate for Payer: Cash Price |
$527.40
|
| Rate for Payer: Devoted Health Medicare |
$298.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$835.05
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Humana Medicare |
$272.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$448.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.49
|
| Rate for Payer: MDX Hawaii PPO |
$852.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$272.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.49
|
| Rate for Payer: University Health Alliance Commercial |
$640.70
|
|
|
DRILL 2.3MM, DRILL-2.3/080
|
Facility
|
OP
|
$630.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: AlohaCare Medicaid |
$315.00
|
| Rate for Payer: AlohaCare Medicare |
$195.30
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Devoted Health Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$195.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$598.50
|
| Rate for Payer: Health Management Network Commercial |
$535.50
|
| Rate for Payer: Humana Medicare |
$195.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$195.30
|
| Rate for Payer: MDX Hawaii PPO |
$611.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$195.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$195.30
|
| Rate for Payer: University Health Alliance Commercial |
$459.21
|
|
|
DRILL 2.3MM, DRILL-2.3/080
|
Facility
|
IP
|
$630.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Health Management Network Commercial |
$535.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.00
|
| Rate for Payer: MDX Hawaii PPO |
$611.10
|
|
|
DRILL 2.4/120C
|
Facility
|
IP
|
$619.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.15 |
| Max. Negotiated Rate |
$600.43 |
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Health Management Network Commercial |
$526.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.10
|
| Rate for Payer: MDX Hawaii PPO |
$600.43
|
|
|
DRILL 2.4/120C
|
Facility
|
OP
|
$619.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.89 |
| Max. Negotiated Rate |
$600.43 |
| Rate for Payer: AlohaCare Medicaid |
$309.50
|
| Rate for Payer: AlohaCare Medicare |
$191.89
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Devoted Health Medicare |
$210.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$588.05
|
| Rate for Payer: Health Management Network Commercial |
$526.15
|
| Rate for Payer: Humana Medicare |
$191.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$315.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$191.89
|
| Rate for Payer: MDX Hawaii PPO |
$600.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.89
|
| Rate for Payer: University Health Alliance Commercial |
$451.19
|
|
|
DRILL 2.4MM PROXIMAL 316-0322
|
Facility
|
IP
|
$683.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$580.55 |
| Max. Negotiated Rate |
$662.51 |
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Health Management Network Commercial |
$580.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$614.70
|
| Rate for Payer: MDX Hawaii PPO |
$662.51
|
|
|
DRILL 2.4MM PROXIMAL 316-0322
|
Facility
|
OP
|
$683.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.73 |
| Max. Negotiated Rate |
$662.51 |
| Rate for Payer: AlohaCare Medicaid |
$341.50
|
| Rate for Payer: AlohaCare Medicare |
$211.73
|
| Rate for Payer: Cash Price |
$409.80
|
| Rate for Payer: Devoted Health Medicare |
$232.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$648.85
|
| Rate for Payer: Health Management Network Commercial |
$580.55
|
| Rate for Payer: Humana Medicare |
$211.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$614.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$348.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.73
|
| Rate for Payer: MDX Hawaii PPO |
$662.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.73
|
| Rate for Payer: University Health Alliance Commercial |
$497.84
|
|
|
DRILL 2.4 QC STERILE
|
Facility
|
IP
|
$242.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
|
|
DRILL 2.4 QC STERILE
|
Facility
|
OP
|
$242.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: AlohaCare Medicaid |
$121.00
|
| Rate for Payer: AlohaCare Medicare |
$75.02
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Devoted Health Medicare |
$82.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$229.90
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Humana Medicare |
$75.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.02
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.02
|
| Rate for Payer: University Health Alliance Commercial |
$176.39
|
|
|
DRILL 2.5 703586
|
Facility
|
IP
|
$856.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$727.60 |
| Max. Negotiated Rate |
$830.32 |
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Health Management Network Commercial |
$727.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$770.40
|
| Rate for Payer: MDX Hawaii PPO |
$830.32
|
|
|
DRILL 2.5 703586
|
Facility
|
OP
|
$856.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.36 |
| Max. Negotiated Rate |
$830.32 |
| Rate for Payer: AlohaCare Medicaid |
$428.00
|
| Rate for Payer: AlohaCare Medicare |
$265.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Devoted Health Medicare |
$291.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$813.20
|
| Rate for Payer: Health Management Network Commercial |
$727.60
|
| Rate for Payer: Humana Medicare |
$265.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$770.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$436.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.36
|
| Rate for Payer: MDX Hawaii PPO |
$830.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$265.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$265.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.36
|
| Rate for Payer: University Health Alliance Commercial |
$623.94
|
|
|
DRILL 2.5MM GLENOID AR-9145K
|
Facility
|
OP
|
$675.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.25 |
| Max. Negotiated Rate |
$654.75 |
| Rate for Payer: AlohaCare Medicaid |
$337.50
|
| Rate for Payer: AlohaCare Medicare |
$209.25
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Devoted Health Medicare |
$229.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.25
|
| Rate for Payer: Health Management Network Commercial |
$573.75
|
| Rate for Payer: Humana Medicare |
$209.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$607.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.25
|
| Rate for Payer: MDX Hawaii PPO |
$654.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$209.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$209.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.25
|
| Rate for Payer: University Health Alliance Commercial |
$492.01
|
|
|
DRILL 2.5MM GLENOID AR-9145K
|
Facility
|
IP
|
$675.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$573.75 |
| Max. Negotiated Rate |
$654.75 |
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Health Management Network Commercial |
$573.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$607.50
|
| Rate for Payer: MDX Hawaii PPO |
$654.75
|
|
|
DRILL 2.6 703691
|
Facility
|
OP
|
$924.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: AlohaCare Medicaid |
$462.00
|
| Rate for Payer: AlohaCare Medicare |
$286.44
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$314.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$286.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$471.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.44
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.44
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
DRILL 2.6 703691
|
Facility
|
IP
|
$924.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|