|
DRILL BIT 3.5X6MM 210451
|
Facility
|
IP
|
$431.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.35 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
|
|
DRILL BIT 3.5X6MM 210451
|
Facility
|
OP
|
$431.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.61 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: AlohaCare Medicaid |
$215.50
|
| Rate for Payer: AlohaCare Medicare |
$133.61
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Devoted Health Medicare |
$146.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$409.45
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Humana Medicare |
$133.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.61
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.61
|
| Rate for Payer: University Health Alliance Commercial |
$314.16
|
|
|
DRILL BIT 3.5X95MM JC 310.36
|
Facility
|
IP
|
$348.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.80 |
| Max. Negotiated Rate |
$337.56 |
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Health Management Network Commercial |
$295.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.20
|
| Rate for Payer: MDX Hawaii PPO |
$337.56
|
|
|
DRILL BIT 3.5X95MM JC 310.36
|
Facility
|
OP
|
$348.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$337.56 |
| Rate for Payer: AlohaCare Medicaid |
$174.00
|
| Rate for Payer: AlohaCare Medicare |
$107.88
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Devoted Health Medicare |
$118.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network Commercial |
$295.80
|
| Rate for Payer: Humana Medicare |
$107.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.88
|
| Rate for Payer: MDX Hawaii PPO |
$337.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.88
|
| Rate for Payer: University Health Alliance Commercial |
$253.66
|
|
|
DRILL BIT 4.0/180MM 1-1103001
|
Facility
|
OP
|
$527.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$511.19 |
| Rate for Payer: AlohaCare Medicaid |
$263.50
|
| Rate for Payer: AlohaCare Medicare |
$163.37
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Devoted Health Medicare |
$179.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$500.65
|
| Rate for Payer: Health Management Network Commercial |
$447.95
|
| Rate for Payer: Humana Medicare |
$163.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$474.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$268.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.37
|
| Rate for Payer: MDX Hawaii PPO |
$511.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.37
|
| Rate for Payer: University Health Alliance Commercial |
$384.13
|
|
|
DRILL BIT 4.0/180MM 1-1103001
|
Facility
|
IP
|
$527.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.95 |
| Max. Negotiated Rate |
$511.19 |
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Health Management Network Commercial |
$447.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$474.30
|
| Rate for Payer: MDX Hawaii PPO |
$511.19
|
|
|
DRILL BIT 4.0 200MM 5085-2-040
|
Facility
|
OP
|
$438.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.78 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$416.10
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$319.26
|
|
|
DRILL BIT 4.0 200MM 5085-2-040
|
Facility
|
IP
|
$438.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
DRILL BIT 4.0MM 2129-57-014
|
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 4.0MM 2129-57-014
|
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 BIT 4.2MM X 145MM
|
Facility
|
IP
|
$938.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$797.30 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Health Management Network Commercial |
$797.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$844.20
|
| Rate for Payer: MDX Hawaii PPO |
$909.86
|
|
|
DRILL BIT 4.2MM X 145MM
|
Facility
|
OP
|
$938.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.78 |
| Max. Negotiated Rate |
$909.86 |
| Rate for Payer: AlohaCare Medicaid |
$469.00
|
| Rate for Payer: AlohaCare Medicare |
$290.78
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Devoted Health Medicare |
$318.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$290.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$891.10
|
| Rate for Payer: Health Management Network Commercial |
$797.30
|
| Rate for Payer: Humana Medicare |
$290.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$844.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$478.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.78
|
| Rate for Payer: MDX Hawaii PPO |
$909.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.78
|
| Rate for Payer: University Health Alliance Commercial |
$683.71
|
|
|
DRILL BIT 4.2X145MM 03.010.101
|
Facility
|
OP
|
$993.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.83 |
| Max. Negotiated Rate |
$963.21 |
| Rate for Payer: AlohaCare Medicaid |
$496.50
|
| Rate for Payer: AlohaCare Medicare |
$307.83
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Devoted Health Medicare |
$337.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$943.35
|
| Rate for Payer: Health Management Network Commercial |
$844.05
|
| Rate for Payer: Humana Medicare |
$307.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$893.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$506.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$307.83
|
| Rate for Payer: MDX Hawaii PPO |
$963.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.83
|
| Rate for Payer: University Health Alliance Commercial |
$723.80
|
|
|
DRILL BIT 4.2X145MM 03.010.101
|
Facility
|
IP
|
$993.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.05 |
| Max. Negotiated Rate |
$963.21 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Health Management Network Commercial |
$844.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$893.70
|
| Rate for Payer: MDX Hawaii PPO |
$963.21
|
|
|
DRILL BIT 4.2X145MM 03.010.104
|
Facility
|
OP
|
$880.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.80 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: AlohaCare Medicaid |
$440.00
|
| Rate for Payer: AlohaCare Medicare |
$272.80
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Devoted Health Medicare |
$299.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$836.00
|
| Rate for Payer: Health Management Network Commercial |
$748.00
|
| Rate for Payer: Humana Medicare |
$272.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$792.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$448.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.80
|
| Rate for Payer: MDX Hawaii PPO |
$853.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$272.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.80
|
| Rate for Payer: University Health Alliance Commercial |
$641.43
|
|
|
DRILL BIT 4.2X145MM 03.010.104
|
Facility
|
IP
|
$880.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$748.00 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Management Network Commercial |
$748.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$792.00
|
| Rate for Payer: MDX Hawaii PPO |
$853.60
|
|
|
DRILL BIT 4.2X330MM 03.010.061
|
Facility
|
OP
|
$1,148.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.88 |
| Max. Negotiated Rate |
$1,113.56 |
| Rate for Payer: AlohaCare Medicaid |
$574.00
|
| Rate for Payer: AlohaCare Medicare |
$355.88
|
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Devoted Health Medicare |
$390.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$355.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,090.60
|
| Rate for Payer: Health Management Network Commercial |
$975.80
|
| Rate for Payer: Humana Medicare |
$355.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,033.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$585.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$355.88
|
| Rate for Payer: MDX Hawaii PPO |
$1,113.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$355.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$355.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$355.88
|
| Rate for Payer: University Health Alliance Commercial |
$836.78
|
|
|
DRILL BIT 4.2X330MM 03.010.061
|
Facility
|
IP
|
$1,148.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.80 |
| Max. Negotiated Rate |
$1,113.56 |
| Rate for Payer: Cash Price |
$688.80
|
| Rate for Payer: Health Management Network Commercial |
$975.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,033.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,113.56
|
|
|
DRILL BIT 4.3MM 02.00024.002
|
Facility
|
OP
|
$980.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$950.60 |
| Rate for Payer: AlohaCare Medicaid |
$490.00
|
| Rate for Payer: AlohaCare Medicare |
$303.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Devoted Health Medicare |
$333.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$931.00
|
| Rate for Payer: Health Management Network Commercial |
$833.00
|
| Rate for Payer: Humana Medicare |
$303.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$882.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$499.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.80
|
| Rate for Payer: MDX Hawaii PPO |
$950.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$303.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.80
|
| Rate for Payer: University Health Alliance Commercial |
$714.32
|
|
|
DRILL BIT 4.3MM 02.00024.002
|
Facility
|
IP
|
$980.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$833.00 |
| Max. Negotiated Rate |
$950.60 |
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Health Management Network Commercial |
$833.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$882.00
|
| Rate for Payer: MDX Hawaii PPO |
$950.60
|
|
|
DRILL BIT 4.3MM 02.00024.346
|
Facility
|
IP
|
$840.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$814.80 |
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Management Network Commercial |
$714.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$756.00
|
| Rate for Payer: MDX Hawaii PPO |
$814.80
|
|
|
DRILL BIT 4.3MM 02.00024.346
|
Facility
|
OP
|
$840.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$814.80 |
| Rate for Payer: AlohaCare Medicaid |
$420.00
|
| Rate for Payer: AlohaCare Medicare |
$260.40
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Devoted Health Medicare |
$285.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$798.00
|
| Rate for Payer: Health Management Network Commercial |
$714.00
|
| Rate for Payer: Humana Medicare |
$260.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$756.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$428.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$260.40
|
| Rate for Payer: MDX Hawaii PPO |
$814.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.40
|
| Rate for Payer: University Health Alliance Commercial |
$612.28
|
|
|
DRILL BIT 4.3MMX300MM 324.213
|
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 4.3MMX300MM 324.213
|
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 4.3X196 705078
|
Facility
|
IP
|
$1,013.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$861.05 |
| Max. Negotiated Rate |
$982.61 |
| Rate for Payer: Cash Price |
$607.80
|
| Rate for Payer: Health Management Network Commercial |
$861.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$911.70
|
| Rate for Payer: MDX Hawaii PPO |
$982.61
|
|