|
OMNIFIT HIP STEM #8 #6097-0835
|
Facility
|
OP
|
$10,332.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,202.92 |
| Max. Negotiated Rate |
$10,022.04 |
| Rate for Payer: AlohaCare Medicaid |
$5,166.00
|
| Rate for Payer: AlohaCare Medicare |
$3,202.92
|
| Rate for Payer: Cash Price |
$6,199.20
|
| Rate for Payer: Devoted Health Medicare |
$3,512.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,202.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,232.40
|
| Rate for Payer: Health Management Network Commercial |
$8,782.20
|
| Rate for Payer: Humana Medicare |
$3,202.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,298.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,269.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,202.92
|
| Rate for Payer: MDX Hawaii PPO |
$10,022.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,202.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,202.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,202.92
|
| Rate for Payer: University Health Alliance Commercial |
$5,785.92
|
|
|
OMNIFIT HIP STEM#9 #6097-0940
|
Facility
|
IP
|
$3,096.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.76 |
| Max. Negotiated Rate |
$3,003.12 |
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,167.20
|
| Rate for Payer: Health Management Network Commercial |
$2,631.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,786.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,003.12
|
| Rate for Payer: University Health Alliance Commercial |
$1,733.76
|
|
|
OMNIFIT HIP STEM#9 #6097-0940
|
Facility
|
OP
|
$3,096.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$3,003.12 |
| Rate for Payer: AlohaCare Medicaid |
$1,548.00
|
| Rate for Payer: AlohaCare Medicare |
$959.76
|
| Rate for Payer: Cash Price |
$1,857.60
|
| Rate for Payer: Devoted Health Medicare |
$1,052.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$959.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,167.20
|
| Rate for Payer: Health Management Network Commercial |
$2,631.60
|
| Rate for Payer: Humana Medicare |
$959.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,786.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,578.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$959.76
|
| Rate for Payer: MDX Hawaii PPO |
$3,003.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$959.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$959.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$959.76
|
| Rate for Payer: University Health Alliance Commercial |
$1,733.76
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [100610]
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
HCPCS J0585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$1,136.84 |
| Rate for Payer: AlohaCare Medicaid |
$586.00
|
| Rate for Payer: AlohaCare Medicare |
$363.32
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Devoted Health Medicare |
$398.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$363.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,113.40
|
| Rate for Payer: Health Management Network Commercial |
$996.20
|
| Rate for Payer: Humana Medicare |
$363.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,054.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$597.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$363.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,136.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$363.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$703.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$363.32
|
| Rate for Payer: University Health Alliance Commercial |
$854.27
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION [100610]
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
HCPCS J0585
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$996.20 |
| Max. Negotiated Rate |
$1,136.84 |
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Health Management Network Commercial |
$996.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,054.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,136.84
|
|
|
ONCONTROL BONE LESION TRAY
|
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
|
|
|
ONCONTROL BONE LESION TRAY
|
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
|
|
|
ONCONTROL BONE MARROW TRAY
|
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
|
|
|
ONCONTROL BONE MARROW TRAY
|
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
|
|
|
ONDANSETRON 16 MG IN 50 ML NS IVPB-CNR FROM MDV (SIMPLE) [4080023]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
|
|
ONDANSETRON 16 MG IN 50 ML NS IVPB-CNR FROM MDV (SIMPLE) [4080023]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.20
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: MDX Hawaii PPO |
$56.26
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET [27697]
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$56.26 |
| Rate for Payer: AlohaCare Medicaid |
$29.00
|
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$17.36
|
| Rate for Payer: AlohaCare Medicare |
$17.98
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$19.04
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.10
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Humana Medicare |
$17.36
|
| Rate for Payer: Humana Medicare |
$17.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.98
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: MDX Hawaii PPO |
$56.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.36
|
| Rate for Payer: University Health Alliance Commercial |
$40.82
|
| Rate for Payer: University Health Alliance Commercial |
$42.28
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION [106349]
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$11.47
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$12.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.15
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.47
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.47
|
| Rate for Payer: University Health Alliance Commercial |
$26.97
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION [106348]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicaid |
$3.50
|
| Rate for Payer: AlohaCare Medicare |
$2.17
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: AlohaCare Medicare |
$1.24
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Devoted Health Medicare |
$1.36
|
| Rate for Payer: Devoted Health Medicare |
$2.38
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Humana Medicare |
$1.24
|
| Rate for Payer: Humana Medicare |
$2.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.24
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.24
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
ONDANSETRON ODT (ZOFRAN) 4 MG (TAKE HOME) [4080383]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
ONDANSETRON ODT (ZOFRAN) 4 MG (TAKE HOME) [4080383]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS Q0162
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$4.65
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$5.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.65
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
OPTISEAL VALVED INTROD 6X13
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: AlohaCare Medicaid |
$455.00
|
| Rate for Payer: AlohaCare Medicare |
$282.10
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Devoted Health Medicare |
$309.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$864.50
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Humana Medicare |
$282.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$819.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.10
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.10
|
| Rate for Payer: University Health Alliance Commercial |
$663.30
|
|
|
OPTISEAL VALVED INTROD 6X13
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$819.00
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
|
|
OPTISEAL VALVED INTROD 6X25
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: AlohaCare Medicaid |
$455.00
|
| Rate for Payer: AlohaCare Medicare |
$282.10
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Devoted Health Medicare |
$309.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$864.50
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Humana Medicare |
$282.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$819.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.10
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.10
|
| Rate for Payer: University Health Alliance Commercial |
$663.30
|
|
|
OPTISEAL VALVED INTROD 6X25
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$819.00
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
|
|
OPTISEAL VALVED INTROD 8X13
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: AlohaCare Medicaid |
$455.00
|
| Rate for Payer: AlohaCare Medicare |
$282.10
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Devoted Health Medicare |
$309.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$864.50
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Humana Medicare |
$282.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$819.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.10
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.10
|
| Rate for Payer: University Health Alliance Commercial |
$663.30
|
|
|
OPTISEAL VALVED INTROD 8X13
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$819.00
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
|
