|
PACK HEAD
|
Facility
|
OP
|
$71.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$22.01
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$24.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.45
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$22.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.01
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.01
|
| Rate for Payer: University Health Alliance Commercial |
$51.75
|
|
|
PACK HEAD
|
Facility
|
IP
|
$71.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
PACKING 4.5CM NASAL
|
Facility
|
OP
|
$99.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$30.69
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$33.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.05
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$30.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.69
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.69
|
| Rate for Payer: University Health Alliance Commercial |
$72.16
|
|
|
PACKING 4.5CM NASAL
|
Facility
|
IP
|
$99.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
PACKING 8CM NASAL
|
Facility
|
IP
|
$146.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.40
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
PACKING 8CM NASAL
|
Facility
|
OP
|
$146.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.26 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: AlohaCare Medicaid |
$73.00
|
| Rate for Payer: AlohaCare Medicare |
$45.26
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Devoted Health Medicare |
$49.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.70
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$45.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.26
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.26
|
| Rate for Payer: University Health Alliance Commercial |
$106.42
|
|
|
PACKING POPE EAR 24MM
|
Facility
|
IP
|
$142.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
|
PACKING POPE EAR 24MM
|
Facility
|
OP
|
$142.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.02 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$48.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.90
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$44.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.02
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.02
|
| Rate for Payer: University Health Alliance Commercial |
$103.50
|
|
|
PACK LAP CHOLE
|
Facility
|
IP
|
$1,218.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,035.30 |
| Max. Negotiated Rate |
$1,181.46 |
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,096.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,181.46
|
|
|
PACK LAP CHOLE
|
Facility
|
OP
|
$1,218.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.58 |
| Max. Negotiated Rate |
$1,181.46 |
| Rate for Payer: AlohaCare Medicaid |
$609.00
|
| Rate for Payer: AlohaCare Medicare |
$377.58
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Devoted Health Medicare |
$414.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$377.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,157.10
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Humana Medicare |
$377.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,096.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$621.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$377.58
|
| Rate for Payer: MDX Hawaii PPO |
$1,181.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$377.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$377.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$377.58
|
| Rate for Payer: University Health Alliance Commercial |
$887.80
|
|
|
PACK NASAL GEL 5.5CM
|
Facility
|
OP
|
$194.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$188.18 |
| Rate for Payer: AlohaCare Medicaid |
$97.00
|
| Rate for Payer: AlohaCare Medicare |
$60.14
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Devoted Health Medicare |
$65.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.30
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Humana Medicare |
$60.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.14
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.14
|
| Rate for Payer: University Health Alliance Commercial |
$141.41
|
|
|
PACK NASAL GEL 5.5CM
|
Facility
|
IP
|
$194.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.90 |
| Max. Negotiated Rate |
$188.18 |
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
|
|
PACK ORTHO EXTREMITY
|
Facility
|
OP
|
$147.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: AlohaCare Medicaid |
$73.50
|
| Rate for Payer: AlohaCare Medicare |
$45.57
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Devoted Health Medicare |
$49.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$139.65
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Humana Medicare |
$45.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.57
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.57
|
| Rate for Payer: University Health Alliance Commercial |
$107.15
|
|
|
PACK ORTHO EXTREMITY
|
Facility
|
IP
|
$147.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.30
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
|
|
PACK ROBOTIC PG55KRHH1
|
Facility
|
OP
|
$292.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$283.24 |
| Rate for Payer: AlohaCare Medicaid |
$146.00
|
| Rate for Payer: AlohaCare Medicare |
$90.52
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Devoted Health Medicare |
$99.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$277.40
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Humana Medicare |
$90.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$148.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.52
|
| Rate for Payer: MDX Hawaii PPO |
$283.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.52
|
| Rate for Payer: University Health Alliance Commercial |
$212.84
|
|
|
PACK ROBOTIC PG55KRHH1
|
Facility
|
IP
|
$292.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.20 |
| Max. Negotiated Rate |
$283.24 |
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Health Management Network Commercial |
$248.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$262.80
|
| Rate for Payer: MDX Hawaii PPO |
$283.24
|
|
|
PACK SINUS ENDOSCOPY
|
Facility
|
OP
|
$389.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.59 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: AlohaCare Medicaid |
$194.50
|
| Rate for Payer: AlohaCare Medicare |
$120.59
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Devoted Health Medicare |
$132.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$369.55
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$120.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.59
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.59
|
| Rate for Payer: University Health Alliance Commercial |
$283.54
|
|
|
PACK SINUS ENDOSCOPY
|
Facility
|
IP
|
$389.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
|
PACK TOTAL JOINT
|
Facility
|
IP
|
$506.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.40
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
|
|
PACK TOTAL JOINT
|
Facility
|
OP
|
$506.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.86 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: AlohaCare Medicaid |
$253.00
|
| Rate for Payer: AlohaCare Medicare |
$156.86
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Devoted Health Medicare |
$172.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$480.70
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Humana Medicare |
$156.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.86
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$156.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.86
|
| Rate for Payer: University Health Alliance Commercial |
$368.82
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS J9267
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$229.89 |
| Rate for Payer: AlohaCare Medicaid |
$118.50
|
| Rate for Payer: AlohaCare Medicaid |
$272.00
|
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$36.89
|
| Rate for Payer: AlohaCare Medicare |
$43.40
|
| Rate for Payer: AlohaCare Medicare |
$73.47
|
| Rate for Payer: AlohaCare Medicare |
$168.64
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Devoted Health Medicare |
$47.60
|
| Rate for Payer: Devoted Health Medicare |
$80.58
|
| Rate for Payer: Devoted Health Medicare |
$40.46
|
| Rate for Payer: Devoted Health Medicare |
$184.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.80
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Health Management Network Commercial |
$201.45
|
| Rate for Payer: Humana Medicare |
$43.40
|
| Rate for Payer: Humana Medicare |
$36.89
|
| Rate for Payer: Humana Medicare |
$73.47
|
| Rate for Payer: Humana Medicare |
$168.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$213.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$168.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
| Rate for Payer: MDX Hawaii PPO |
$229.89
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.89
|
| Rate for Payer: University Health Alliance Commercial |
$396.52
|
| Rate for Payer: University Health Alliance Commercial |
$172.75
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
| Rate for Payer: University Health Alliance Commercial |
$102.05
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS [31025]
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS J9267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Health Management Network Commercial |
$201.45
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$213.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: MDX Hawaii PPO |
$229.89
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG/20ML IV (WET SUSR VIAL) [43040475]
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
HCPCS J9264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.53 |
| Max. Negotiated Rate |
$2,325.09 |
| Rate for Payer: AlohaCare Medicaid |
$1,198.50
|
| Rate for Payer: AlohaCare Medicare |
$743.07
|
| Rate for Payer: Cash Price |
$1,438.20
|
| Rate for Payer: Cash Price |
$1,438.20
|
| Rate for Payer: Devoted Health Medicare |
$814.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$743.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,277.15
|
| Rate for Payer: Health Management Network Commercial |
$2,037.45
|
| Rate for Payer: Humana Medicare |
$743.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,157.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,222.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$743.07
|
| Rate for Payer: MDX Hawaii PPO |
$2,325.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$743.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$743.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,438.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$743.07
|
| Rate for Payer: University Health Alliance Commercial |
$1,747.17
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG/20ML IV (WET SUSR VIAL) [43040475]
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
HCPCS J9264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,037.45 |
| Max. Negotiated Rate |
$2,325.09 |
| Rate for Payer: Cash Price |
$1,438.20
|
| Rate for Payer: Health Management Network Commercial |
$2,037.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,157.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,325.09
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION [40475]
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
HCPCS J9264
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,037.45 |
| Max. Negotiated Rate |
$2,325.09 |
| Rate for Payer: Cash Price |
$1,438.20
|
| Rate for Payer: Cash Price |
$1,480.20
|
| Rate for Payer: Health Management Network Commercial |
$2,096.95
|
| Rate for Payer: Health Management Network Commercial |
$2,037.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,157.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,220.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,325.09
|
| Rate for Payer: MDX Hawaii PPO |
$2,392.99
|
|
