|
DRILL 2.7 #00-2360-205-27
|
Facility
|
IP
|
$863.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.55 |
| Max. Negotiated Rate |
$837.11 |
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Health Management Network Commercial |
$733.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.70
|
| Rate for Payer: MDX Hawaii PPO |
$837.11
|
|
|
DRILL 2.7 #00-2360-205-27
|
Facility
|
OP
|
$863.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.53 |
| Max. Negotiated Rate |
$837.11 |
| Rate for Payer: AlohaCare Medicaid |
$431.50
|
| Rate for Payer: AlohaCare Medicare |
$267.53
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Devoted Health Medicare |
$293.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$267.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$819.85
|
| Rate for Payer: Health Management Network Commercial |
$733.55
|
| Rate for Payer: Humana Medicare |
$267.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$440.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.53
|
| Rate for Payer: MDX Hawaii PPO |
$837.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$267.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$267.53
|
| Rate for Payer: University Health Alliance Commercial |
$629.04
|
|
|
DRILL-2.7/110C S
|
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-2.7/110C S
|
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 2.75MM, .066 CANNULATION
|
Facility
|
IP
|
$1,752.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,489.20 |
| Max. Negotiated Rate |
$1,699.44 |
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Health Management Network Commercial |
$1,489.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,576.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,699.44
|
|
|
DRILL 2.75MM, .066 CANNULATION
|
Facility
|
OP
|
$1,752.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.12 |
| Max. Negotiated Rate |
$1,699.44 |
| Rate for Payer: AlohaCare Medicaid |
$876.00
|
| Rate for Payer: AlohaCare Medicare |
$543.12
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Devoted Health Medicare |
$595.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,664.40
|
| Rate for Payer: Health Management Network Commercial |
$1,489.20
|
| Rate for Payer: Humana Medicare |
$543.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,576.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$893.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$543.12
|
| Rate for Payer: MDX Hawaii PPO |
$1,699.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.12
|
| Rate for Payer: University Health Alliance Commercial |
$1,277.03
|
|
|
DRILL 2.7MM CANN QR 316-0427
|
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 2.7MM CANN QR 316-0427
|
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 2.7MM DISTAL LCK AR-2669
|
Facility
|
IP
|
$394.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.90 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
|
|
DRILL 2.7MM DISTAL LCK AR-2669
|
Facility
|
OP
|
$394.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: AlohaCare Medicaid |
$197.00
|
| Rate for Payer: AlohaCare Medicare |
$122.14
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Devoted Health Medicare |
$133.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$374.30
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Humana Medicare |
$122.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.14
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.14
|
| Rate for Payer: University Health Alliance Commercial |
$287.19
|
|
|
DRILL 2.7X40 DRLL-SSC-27040
|
Facility
|
OP
|
$536.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.16 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: AlohaCare Medicaid |
$268.00
|
| Rate for Payer: AlohaCare Medicare |
$166.16
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Devoted Health Medicare |
$182.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$509.20
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Humana Medicare |
$166.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.16
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.16
|
| Rate for Payer: University Health Alliance Commercial |
$390.69
|
|
|
DRILL 2.7X40 DRLL-SSC-27040
|
Facility
|
IP
|
$536.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
|
|
DRILL 2.7X70 IJS-CDC-2770
|
Facility
|
IP
|
$900.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Health Management Network Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.00
|
| Rate for Payer: MDX Hawaii PPO |
$873.00
|
|
|
DRILL 2.7X70 IJS-CDC-2770
|
Facility
|
OP
|
$900.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: AlohaCare Medicaid |
$450.00
|
| Rate for Payer: AlohaCare Medicare |
$279.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Devoted Health Medicare |
$306.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$855.00
|
| Rate for Payer: Health Management Network Commercial |
$765.00
|
| Rate for Payer: Humana Medicare |
$279.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$873.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.00
|
| Rate for Payer: University Health Alliance Commercial |
$656.01
|
|
|
DRILL 2.9MM PROX CORT 316-0317
|
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 2.9MM PROX CORT 316-0317
|
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 3.0 110MM 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 3.0 110MM 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 3.1 703585
|
Facility
|
IP
|
$860.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$731.00 |
| Max. Negotiated Rate |
$834.20 |
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Health Management Network Commercial |
$731.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$774.00
|
| Rate for Payer: MDX Hawaii PPO |
$834.20
|
|
|
DRILL 3.1 703585
|
Facility
|
OP
|
$860.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.60 |
| Max. Negotiated Rate |
$834.20 |
| Rate for Payer: AlohaCare Medicaid |
$430.00
|
| Rate for Payer: AlohaCare Medicare |
$266.60
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Devoted Health Medicare |
$292.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$266.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$817.00
|
| Rate for Payer: Health Management Network Commercial |
$731.00
|
| Rate for Payer: Humana Medicare |
$266.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$774.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$438.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$266.60
|
| Rate for Payer: MDX Hawaii PPO |
$834.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$266.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$266.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$266.60
|
| Rate for Payer: University Health Alliance Commercial |
$626.85
|
|
|
DRILL 3.2 150MM DRILL-3.2/150C
|
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 3.2 150MM DRILL-3.2/150C
|
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 3.2 SHORT GRAD BRAD PT
|
Facility
|
IP
|
$1,173.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.05 |
| Max. Negotiated Rate |
$1,137.81 |
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Health Management Network Commercial |
$997.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,055.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,137.81
|
|
|
DRILL 3.2 SHORT GRAD BRAD PT
|
Facility
|
OP
|
$1,173.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.63 |
| Max. Negotiated Rate |
$1,137.81 |
| Rate for Payer: AlohaCare Medicaid |
$586.50
|
| Rate for Payer: AlohaCare Medicare |
$363.63
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Devoted Health Medicare |
$398.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$363.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,114.35
|
| Rate for Payer: Health Management Network Commercial |
$997.05
|
| Rate for Payer: Humana Medicare |
$363.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,055.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$598.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$363.63
|
| Rate for Payer: MDX Hawaii PPO |
$1,137.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$363.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$363.63
|
| Rate for Payer: University Health Alliance Commercial |
$855.00
|
|
|
DRILL 3.3X110MM 4806-110-33
|
Facility
|
OP
|
$638.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.78 |
| Max. Negotiated Rate |
$618.86 |
| Rate for Payer: AlohaCare Medicaid |
$319.00
|
| Rate for Payer: AlohaCare Medicare |
$197.78
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Devoted Health Medicare |
$216.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$606.10
|
| Rate for Payer: Health Management Network Commercial |
$542.30
|
| Rate for Payer: Humana Medicare |
$197.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$574.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.78
|
| Rate for Payer: MDX Hawaii PPO |
$618.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$197.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.78
|
| Rate for Payer: University Health Alliance Commercial |
$465.04
|
|