|
ROD TL THREADED 100MM 51-10310
|
Facility
|
OP
|
$376.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: AlohaCare Medicaid |
$188.00
|
| Rate for Payer: AlohaCare Medicare |
$116.56
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Devoted Health Medicare |
$127.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.20
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Humana Medicare |
$116.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.56
|
| Rate for Payer: MDX Hawaii PPO |
$364.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.56
|
| Rate for Payer: University Health Alliance Commercial |
$274.07
|
|
|
ROD TL THREADED 100MM 51-10310
|
Facility
|
IP
|
$376.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$319.60 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Health Management Network Commercial |
$319.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.40
|
| Rate for Payer: MDX Hawaii PPO |
$364.72
|
|
|
ROD TL THREADED 150MM 51-10550
|
Facility
|
OP
|
$252.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: AlohaCare Medicaid |
$126.00
|
| Rate for Payer: AlohaCare Medicare |
$78.12
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Devoted Health Medicare |
$85.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$239.40
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Humana Medicare |
$78.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.12
|
| Rate for Payer: MDX Hawaii PPO |
$244.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.12
|
| Rate for Payer: University Health Alliance Commercial |
$183.68
|
|
|
ROD TL THREADED 150MM 51-10550
|
Facility
|
IP
|
$252.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.80
|
| Rate for Payer: MDX Hawaii PPO |
$244.44
|
|
|
ROLLER BALL ELECTRODE 24F #RE
|
Facility
|
OP
|
$454.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.74 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: AlohaCare Medicaid |
$227.00
|
| Rate for Payer: AlohaCare Medicare |
$140.74
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Devoted Health Medicare |
$154.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$431.30
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$140.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.74
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.74
|
| Rate for Payer: University Health Alliance Commercial |
$330.92
|
|
|
ROLLER BALL ELECTRODE 24F #RE
|
Facility
|
IP
|
$454.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
ROMIPLOSTIM 250 MCG/0.5ML SC (WET SOLR VIAL) [43093566]
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
HCPCS J2796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$908.65 |
| Max. Negotiated Rate |
$1,036.93 |
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Cash Price |
$2,282.40
|
| Rate for Payer: Health Management Network Commercial |
$908.65
|
| Rate for Payer: Health Management Network Commercial |
$3,233.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$962.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,423.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,689.88
|
| Rate for Payer: MDX Hawaii PPO |
$1,036.93
|
|
|
ROMIPLOSTIM 250 MCG/0.5ML SC (WET SOLR VIAL) [43093566]
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
HCPCS J2796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.05 |
| Max. Negotiated Rate |
$1,036.93 |
| Rate for Payer: AlohaCare Medicaid |
$534.50
|
| Rate for Payer: AlohaCare Medicaid |
$1,902.00
|
| Rate for Payer: AlohaCare Medicare |
$1,179.24
|
| Rate for Payer: AlohaCare Medicare |
$331.39
|
| Rate for Payer: Cash Price |
$2,282.40
|
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Cash Price |
$641.40
|
| Rate for Payer: Cash Price |
$2,282.40
|
| Rate for Payer: Devoted Health Medicare |
$363.46
|
| Rate for Payer: Devoted Health Medicare |
$1,293.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,179.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$331.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,015.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,613.80
|
| Rate for Payer: Health Management Network Commercial |
$3,233.40
|
| Rate for Payer: Health Management Network Commercial |
$908.65
|
| Rate for Payer: Humana Medicare |
$331.39
|
| Rate for Payer: Humana Medicare |
$1,179.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$962.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,423.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,940.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$545.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$331.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,179.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,036.93
|
| Rate for Payer: MDX Hawaii PPO |
$3,689.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,179.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$331.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,179.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,282.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$641.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$331.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,179.24
|
| Rate for Payer: University Health Alliance Commercial |
$779.19
|
| Rate for Payer: University Health Alliance Commercial |
$2,772.74
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
|
IP
|
$3,804.00
|
|
|
Service Code
|
HCPCS J2802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,233.40 |
| Max. Negotiated Rate |
$3,689.88 |
| Rate for Payer: Cash Price |
$2,282.40
|
| Rate for Payer: Health Management Network Commercial |
$3,233.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,423.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,689.88
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION [93566]
|
Facility
|
OP
|
$3,804.00
|
|
|
Service Code
|
HCPCS J2802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$3,689.88 |
| Rate for Payer: AlohaCare Medicaid |
$1,902.00
|
| Rate for Payer: AlohaCare Medicare |
$1,179.24
|
| Rate for Payer: Cash Price |
$2,282.40
|
| Rate for Payer: Cash Price |
$2,282.40
|
| Rate for Payer: Devoted Health Medicare |
$1,293.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,179.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,613.80
|
| Rate for Payer: Health Management Network Commercial |
$3,233.40
|
| Rate for Payer: Humana Medicare |
$1,179.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,423.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,940.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,179.24
|
| Rate for Payer: MDX Hawaii PPO |
$3,689.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,179.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,179.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,282.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,179.24
|
| Rate for Payer: University Health Alliance Commercial |
$2,772.74
|
|
|
ROMIPLOSTIM 500 MCG/ML SC (WET SOLR VIAL) [43093567]
|
Facility
|
OP
|
$7,108.00
|
|
|
Service Code
|
HCPCS J2796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.05 |
| Max. Negotiated Rate |
$6,894.76 |
| Rate for Payer: AlohaCare Medicaid |
$3,554.00
|
| Rate for Payer: AlohaCare Medicare |
$2,203.48
|
| Rate for Payer: Cash Price |
$4,264.80
|
| Rate for Payer: Cash Price |
$4,264.80
|
| Rate for Payer: Devoted Health Medicare |
$2,416.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$101.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,203.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$101.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,752.60
|
| Rate for Payer: Health Management Network Commercial |
$6,041.80
|
| Rate for Payer: Humana Medicare |
$2,203.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,397.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,625.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,203.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,894.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,203.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,203.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,264.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,203.48
|
| Rate for Payer: University Health Alliance Commercial |
$5,181.02
|
|
|
ROMIPLOSTIM 500 MCG/ML SC (WET SOLR VIAL) [43093567]
|
Facility
|
IP
|
$7,108.00
|
|
|
Service Code
|
HCPCS J2796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,041.80 |
| Max. Negotiated Rate |
$6,894.76 |
| Rate for Payer: Cash Price |
$4,264.80
|
| Rate for Payer: Health Management Network Commercial |
$6,041.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,397.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,894.76
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]
|
Facility
|
OP
|
$7,108.00
|
|
|
Service Code
|
HCPCS J2802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$6,894.76 |
| Rate for Payer: AlohaCare Medicaid |
$3,554.00
|
| Rate for Payer: AlohaCare Medicare |
$2,203.48
|
| Rate for Payer: Cash Price |
$4,264.80
|
| Rate for Payer: Cash Price |
$4,264.80
|
| Rate for Payer: Devoted Health Medicare |
$2,416.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,203.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,752.60
|
| Rate for Payer: Health Management Network Commercial |
$6,041.80
|
| Rate for Payer: Humana Medicare |
$2,203.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,397.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,625.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,203.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,894.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,203.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,203.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,264.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,203.48
|
| Rate for Payer: University Health Alliance Commercial |
$5,181.02
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION [93567]
|
Facility
|
IP
|
$7,108.00
|
|
|
Service Code
|
HCPCS J2802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,041.80 |
| Max. Negotiated Rate |
$6,894.76 |
| Rate for Payer: Cash Price |
$4,264.80
|
| Rate for Payer: Health Management Network Commercial |
$6,041.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,397.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,894.76
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE [167848]
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
HCPCS J3111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$2,015.66 |
| Rate for Payer: AlohaCare Medicaid |
$1,039.00
|
| Rate for Payer: AlohaCare Medicare |
$644.18
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Devoted Health Medicare |
$706.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$644.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,974.10
|
| Rate for Payer: Health Management Network Commercial |
$1,766.30
|
| Rate for Payer: Humana Medicare |
$644.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,870.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,059.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$644.18
|
| Rate for Payer: MDX Hawaii PPO |
$2,015.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$644.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$644.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,246.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$644.18
|
| Rate for Payer: University Health Alliance Commercial |
$1,514.65
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE [167848]
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
HCPCS J3111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,766.30 |
| Max. Negotiated Rate |
$2,015.66 |
| Rate for Payer: Cash Price |
$1,246.80
|
| Rate for Payer: Health Management Network Commercial |
$1,766.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,870.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,015.66
|
|
|
ROOKE BOOT BK PROTECTOR BK-406
|
Facility
|
IP
|
$977.00
|
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
ROOKE BOOT BK PROTECTOR BK-406
|
Facility
|
OP
|
$977.00
|
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$302.87 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$302.87
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Devoted Health Medicare |
$332.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$302.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$302.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.87
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$302.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$302.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$302.87
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBCUTANEOUS SYRINGE [182609]
|
Facility
|
IP
|
$11,528.00
|
|
|
Service Code
|
HCPCS J3590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9,798.80 |
| Max. Negotiated Rate |
$11,182.16 |
| Rate for Payer: Cash Price |
$6,916.80
|
| Rate for Payer: Health Management Network Commercial |
$9,798.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,375.20
|
| Rate for Payer: MDX Hawaii PPO |
$11,182.16
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION [18192]
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$10.23
|
| Rate for Payer: AlohaCare Medicare |
$10.54
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Devoted Health Medicare |
$11.22
|
| Rate for Payer: Devoted Health Medicare |
$11.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.30
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$10.23
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.54
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.23
|
| Rate for Payer: University Health Alliance Commercial |
$24.05
|
| Rate for Payer: University Health Alliance Commercial |
$24.78
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION [18195]
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2795
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$29.45
|
| Rate for Payer: AlohaCare Medicare |
$10.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$11.56
|
| Rate for Payer: Devoted Health Medicare |
$32.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Humana Medicare |
$29.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.45
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.45
|
| Rate for Payer: University Health Alliance Commercial |
$24.78
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
ROSEN CRVED WIRE GUIDE
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS C1769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.45 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$29.45
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Devoted Health Medicare |
$32.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Humana Medicare |
$29.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.45
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.45
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
ROSEN CRVED WIRE GUIDE
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS C1769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
|
