|
DRILL BIT 3.2MM 2129-57-012
|
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 BIT 3.2MM X 145MM
|
Facility
|
IP
|
$776.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.60 |
| Max. Negotiated Rate |
$752.72 |
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Health Management Network Commercial |
$659.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$698.40
|
| Rate for Payer: MDX Hawaii PPO |
$752.72
|
|
|
DRILL BIT 3.2MM X 145MM
|
Facility
|
OP
|
$776.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.56 |
| Max. Negotiated Rate |
$752.72 |
| Rate for Payer: AlohaCare Medicaid |
$388.00
|
| Rate for Payer: AlohaCare Medicare |
$240.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Devoted Health Medicare |
$263.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$737.20
|
| Rate for Payer: Health Management Network Commercial |
$659.60
|
| Rate for Payer: Humana Medicare |
$240.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$698.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$395.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.56
|
| Rate for Payer: MDX Hawaii PPO |
$752.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.56
|
| Rate for Payer: University Health Alliance Commercial |
$565.63
|
|
|
DRILL BIT 3.2MMX300MM 324.212
|
Facility
|
IP
|
$841.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.85 |
| Max. Negotiated Rate |
$815.77 |
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Health Management Network Commercial |
$714.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$756.90
|
| Rate for Payer: MDX Hawaii PPO |
$815.77
|
|
|
DRILL BIT 3.2MMX300MM 324.212
|
Facility
|
OP
|
$841.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$815.77 |
| Rate for Payer: AlohaCare Medicaid |
$420.50
|
| Rate for Payer: AlohaCare Medicare |
$260.71
|
| Rate for Payer: Cash Price |
$504.60
|
| Rate for Payer: Devoted Health Medicare |
$285.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$798.95
|
| Rate for Payer: Health Management Network Commercial |
$714.85
|
| Rate for Payer: Humana Medicare |
$260.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$756.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$260.71
|
| Rate for Payer: MDX Hawaii PPO |
$815.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.71
|
| Rate for Payer: University Health Alliance Commercial |
$613.00
|
|
|
DRILL BIT 3.2, THREE-FLUTED
|
Facility
|
OP
|
$997.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.07 |
| Max. Negotiated Rate |
$967.09 |
| Rate for Payer: AlohaCare Medicaid |
$498.50
|
| Rate for Payer: AlohaCare Medicare |
$309.07
|
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Devoted Health Medicare |
$338.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$309.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$947.15
|
| Rate for Payer: Health Management Network Commercial |
$847.45
|
| Rate for Payer: Humana Medicare |
$309.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$508.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$309.07
|
| Rate for Payer: MDX Hawaii PPO |
$967.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$309.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$309.07
|
| Rate for Payer: University Health Alliance Commercial |
$726.71
|
|
|
DRILL BIT 3.2, THREE-FLUTED
|
Facility
|
IP
|
$997.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.45 |
| Max. Negotiated Rate |
$967.09 |
| Rate for Payer: Cash Price |
$598.20
|
| Rate for Payer: Health Management Network Commercial |
$847.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$897.30
|
| Rate for Payer: MDX Hawaii PPO |
$967.09
|
|
|
DRILL BIT 3.2X130MM JC 310.32
|
Facility
|
OP
|
$461.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.91 |
| Max. Negotiated Rate |
$447.17 |
| Rate for Payer: AlohaCare Medicaid |
$230.50
|
| Rate for Payer: AlohaCare Medicare |
$142.91
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Devoted Health Medicare |
$156.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$437.95
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Humana Medicare |
$142.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$414.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$235.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.91
|
| Rate for Payer: MDX Hawaii PPO |
$447.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.91
|
| Rate for Payer: University Health Alliance Commercial |
$336.02
|
|
|
DRILL BIT 3.2X130MM JC 310.32
|
Facility
|
IP
|
$461.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.85 |
| Max. Negotiated Rate |
$447.17 |
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Health Management Network Commercial |
$391.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$414.90
|
| Rate for Payer: MDX Hawaii PPO |
$447.17
|
|
|
DRILL BIT 3.2X315 AO 703542
|
Facility
|
IP
|
$1,078.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.30 |
| Max. Negotiated Rate |
$1,045.66 |
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$970.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,045.66
|
|
|
DRILL BIT 3.2X315 AO 703542
|
Facility
|
OP
|
$1,078.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$1,045.66 |
| Rate for Payer: AlohaCare Medicaid |
$539.00
|
| Rate for Payer: AlohaCare Medicare |
$334.18
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Devoted Health Medicare |
$366.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$334.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,024.10
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Humana Medicare |
$334.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$970.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$549.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$334.18
|
| Rate for Payer: MDX Hawaii PPO |
$1,045.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$334.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$334.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$334.18
|
| Rate for Payer: University Health Alliance Commercial |
$785.75
|
|
|
DRILL BIT 3.3MM 02.00024.118
|
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 BIT 3.3MM 02.00024.118
|
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 BIT 3.3X25MM #2107-3325
|
Facility
|
OP
|
$578.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.18 |
| Max. Negotiated Rate |
$560.66 |
| Rate for Payer: AlohaCare Medicaid |
$289.00
|
| Rate for Payer: AlohaCare Medicare |
$179.18
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Devoted Health Medicare |
$196.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$549.10
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Humana Medicare |
$179.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.18
|
| Rate for Payer: MDX Hawaii PPO |
$560.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.18
|
| Rate for Payer: University Health Alliance Commercial |
$421.30
|
|
|
DRILL BIT 3.3X25MM #2107-3325
|
Facility
|
IP
|
$578.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.30 |
| Max. Negotiated Rate |
$560.66 |
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Health Management Network Commercial |
$491.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.20
|
| Rate for Payer: MDX Hawaii PPO |
$560.66
|
|
|
DRILL BIT 3.3X25MM 7005-3325S
|
Facility
|
OP
|
$537.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.47 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: AlohaCare Medicaid |
$268.50
|
| Rate for Payer: AlohaCare Medicare |
$166.47
|
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Devoted Health Medicare |
$182.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$510.15
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Humana Medicare |
$166.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.47
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.47
|
| Rate for Payer: University Health Alliance Commercial |
$391.42
|
|
|
DRILL BIT 3.3X25MM 7005-3325S
|
Facility
|
IP
|
$537.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: Cash Price |
$322.20
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
|
|
DRILL BIT 3.5 230MM 1806-3540S
|
Facility
|
IP
|
$739.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.15 |
| Max. Negotiated Rate |
$716.83 |
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Health Management Network Commercial |
$628.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$665.10
|
| Rate for Payer: MDX Hawaii PPO |
$716.83
|
|
|
DRILL BIT 3.5 230MM 1806-3540S
|
Facility
|
OP
|
$739.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$716.83 |
| Rate for Payer: AlohaCare Medicaid |
$369.50
|
| Rate for Payer: AlohaCare Medicare |
$229.09
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Devoted Health Medicare |
$251.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$229.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$702.05
|
| Rate for Payer: Health Management Network Commercial |
$628.15
|
| Rate for Payer: Humana Medicare |
$229.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$665.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$229.09
|
| Rate for Payer: MDX Hawaii PPO |
$716.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$229.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$229.09
|
| Rate for Payer: University Health Alliance Commercial |
$538.66
|
|
|
DRILL BIT 3.5 AR-4160-35
|
Facility
|
IP
|
$332.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$322.04 |
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.80
|
| Rate for Payer: MDX Hawaii PPO |
$322.04
|
|
|
DRILL BIT 3.5 AR-4160-35
|
Facility
|
OP
|
$332.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.92 |
| Max. Negotiated Rate |
$322.04 |
| Rate for Payer: AlohaCare Medicaid |
$166.00
|
| Rate for Payer: AlohaCare Medicare |
$102.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Devoted Health Medicare |
$112.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$315.40
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Humana Medicare |
$102.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.92
|
| Rate for Payer: MDX Hawaii PPO |
$322.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.92
|
| Rate for Payer: University Health Alliance Commercial |
$241.99
|
|
|
DRILL BIT 3.5MM
|
Facility
|
IP
|
$1,193.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.05 |
| Max. Negotiated Rate |
$1,157.21 |
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Health Management Network Commercial |
$1,014.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,073.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,157.21
|
|
|
DRILL BIT 3.5MM
|
Facility
|
OP
|
$1,193.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.83 |
| Max. Negotiated Rate |
$1,157.21 |
| Rate for Payer: AlohaCare Medicaid |
$596.50
|
| Rate for Payer: AlohaCare Medicare |
$369.83
|
| Rate for Payer: Cash Price |
$715.80
|
| Rate for Payer: Devoted Health Medicare |
$405.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,133.35
|
| Rate for Payer: Health Management Network Commercial |
$1,014.05
|
| Rate for Payer: Humana Medicare |
$369.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,073.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$608.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.83
|
| Rate for Payer: MDX Hawaii PPO |
$1,157.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$369.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.83
|
| Rate for Payer: University Health Alliance Commercial |
$869.58
|
|
|
DRILL BIT 3.5X110MM QC 315.35
|
Facility
|
IP
|
$600.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
|
|
DRILL BIT 3.5X110MM QC 315.35
|
Facility
|
OP
|
$600.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: AlohaCare Medicaid |
$300.00
|
| Rate for Payer: AlohaCare Medicare |
$186.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Devoted Health Medicare |
$204.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$186.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.00
|
| Rate for Payer: Health Management Network Commercial |
$510.00
|
| Rate for Payer: Humana Medicare |
$186.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$540.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.00
|
| Rate for Payer: MDX Hawaii PPO |
$582.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$186.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$186.00
|
| Rate for Payer: University Health Alliance Commercial |
$437.34
|
|