|
TORPEDO 4.0MMX7CM AR-7400TD
|
Facility
|
IP
|
$379.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.15 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
|
|
TORPEDO 4.0MMX7CM AR-7400TD
|
Facility
|
OP
|
$379.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: AlohaCare Medicaid |
$189.50
|
| Rate for Payer: AlohaCare Medicare |
$117.49
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Devoted Health Medicare |
$128.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$360.05
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Humana Medicare |
$117.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.49
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.49
|
| Rate for Payer: University Health Alliance Commercial |
$276.25
|
|
|
TORPEDO 4MMX13CM AR-8400TD
|
Facility
|
IP
|
$544.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
|
|
TORPEDO 4MMX13CM AR-8400TD
|
Facility
|
OP
|
$544.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.64 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: AlohaCare Medicaid |
$272.00
|
| Rate for Payer: AlohaCare Medicare |
$168.64
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Devoted Health Medicare |
$184.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.80
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Humana Medicare |
$168.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$168.64
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.64
|
| Rate for Payer: University Health Alliance Commercial |
$396.52
|
|
|
TORQUE-OLCOTT TORQUE DEVICE (O
|
Facility
|
OP
|
$96.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$29.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Devoted Health Medicare |
$32.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$29.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.76
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.76
|
| Rate for Payer: University Health Alliance Commercial |
$69.97
|
|
|
TORQUE-OLCOTT TORQUE DEVICE (O
|
Facility
|
IP
|
$96.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
TORSEMIDE 20 MG TABLET [18293]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084053911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
TORSEMIDE 20 MG TABLET [18293]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 50268075615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
TORSEMIDE 20 MG TABLET [18293]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084053901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
TORSEMIDE 20 MG TABLET [18293]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084053901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
TORSEMIDE 20 MG TABLET [18293]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084053911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
TORSEMIDE 20 MG TABLET [18293]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 50268075615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
TOTAL HIP FEMORAL STEM 52-3418
|
Facility
|
IP
|
$8,873.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,968.88 |
| Max. Negotiated Rate |
$8,606.81 |
| Rate for Payer: Cash Price |
$5,323.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,211.10
|
| Rate for Payer: Health Management Network Commercial |
$7,542.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,985.70
|
| Rate for Payer: MDX Hawaii PPO |
$8,606.81
|
| Rate for Payer: University Health Alliance Commercial |
$4,968.88
|
|
|
TOTAL HIP FEMORAL STEM 52-3418
|
Facility
|
OP
|
$8,873.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,750.63 |
| Max. Negotiated Rate |
$8,606.81 |
| Rate for Payer: AlohaCare Medicaid |
$4,436.50
|
| Rate for Payer: AlohaCare Medicare |
$2,750.63
|
| Rate for Payer: Cash Price |
$5,323.80
|
| Rate for Payer: Devoted Health Medicare |
$3,016.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,750.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,211.10
|
| Rate for Payer: Health Management Network Commercial |
$7,542.05
|
| Rate for Payer: Humana Medicare |
$2,750.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,985.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,525.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,750.63
|
| Rate for Payer: MDX Hawaii PPO |
$8,606.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,750.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,750.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,750.63
|
| Rate for Payer: University Health Alliance Commercial |
$4,968.88
|
|
|
TOTAL HIP PROXIMAL 18D 55-0524
|
Facility
|
OP
|
$4,310.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.10 |
| Max. Negotiated Rate |
$4,180.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,155.00
|
| Rate for Payer: AlohaCare Medicare |
$1,336.10
|
| Rate for Payer: Cash Price |
$2,586.00
|
| Rate for Payer: Devoted Health Medicare |
$1,465.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,336.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,017.00
|
| Rate for Payer: Health Management Network Commercial |
$3,663.50
|
| Rate for Payer: Humana Medicare |
$1,336.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,879.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,198.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,336.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,180.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,336.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,336.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,336.10
|
| Rate for Payer: University Health Alliance Commercial |
$2,413.60
|
|
|
TOTAL HIP PROXIMAL 18D 55-0524
|
Facility
|
IP
|
$4,310.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,413.60 |
| Max. Negotiated Rate |
$4,180.70 |
| Rate for Payer: Cash Price |
$2,586.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,017.00
|
| Rate for Payer: Health Management Network Commercial |
$3,663.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,879.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,180.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,413.60
|
|
|
TOTAL STABILIZER FEM 5512-F-40
|
Facility
|
IP
|
$12,283.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,878.48 |
| Max. Negotiated Rate |
$11,914.51 |
| Rate for Payer: Cash Price |
$7,369.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,598.10
|
| Rate for Payer: Health Management Network Commercial |
$10,440.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,054.70
|
| Rate for Payer: MDX Hawaii PPO |
$11,914.51
|
| Rate for Payer: University Health Alliance Commercial |
$6,878.48
|
|
|
TOTAL STABILIZER FEM 5512-F-40
|
Facility
|
OP
|
$12,283.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,807.73 |
| Max. Negotiated Rate |
$11,914.51 |
| Rate for Payer: AlohaCare Medicaid |
$6,141.50
|
| Rate for Payer: AlohaCare Medicare |
$3,807.73
|
| Rate for Payer: Cash Price |
$7,369.80
|
| Rate for Payer: Devoted Health Medicare |
$4,176.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,807.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,598.10
|
| Rate for Payer: Health Management Network Commercial |
$10,440.55
|
| Rate for Payer: Humana Medicare |
$3,807.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,054.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,264.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,807.73
|
| Rate for Payer: MDX Hawaii PPO |
$11,914.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,807.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,807.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,807.73
|
| Rate for Payer: University Health Alliance Commercial |
$6,878.48
|
|
|
TOURN CUFF STERILE 12X3 15-110
|
Facility
|
IP
|
$170.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
|
|
TOURN CUFF STERILE 12X3 15-110
|
Facility
|
OP
|
$170.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$85.00
|
| Rate for Payer: AlohaCare Medicare |
$52.70
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Devoted Health Medicare |
$57.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.50
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Humana Medicare |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.70
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.70
|
| Rate for Payer: University Health Alliance Commercial |
$123.91
|
|
|
TOURN CUFF STERILE 18X4 15-130
|
Facility
|
IP
|
$187.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$181.39 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.30
|
| Rate for Payer: MDX Hawaii PPO |
$181.39
|
|
|
TOURN CUFF STERILE 18X4 15-130
|
Facility
|
OP
|
$187.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$181.39 |
| Rate for Payer: AlohaCare Medicaid |
$93.50
|
| Rate for Payer: AlohaCare Medicare |
$57.97
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$63.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$177.65
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Humana Medicare |
$57.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.97
|
| Rate for Payer: MDX Hawaii PPO |
$181.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.97
|
| Rate for Payer: University Health Alliance Commercial |
$136.30
|
|
|
TOURN CUFF STERILE 24X4 15-140
|
Facility
|
IP
|
$195.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$189.15
|
|
|
TOURN CUFF STERILE 24X4 15-140
|
Facility
|
OP
|
$195.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: AlohaCare Medicaid |
$97.50
|
| Rate for Payer: AlohaCare Medicare |
$60.45
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$66.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.25
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Humana Medicare |
$60.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.45
|
| Rate for Payer: MDX Hawaii PPO |
$189.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.45
|
| Rate for Payer: University Health Alliance Commercial |
$142.14
|
|
|
TOURN CUFF STERILE 30X5 15-150
|
Facility
|
OP
|
$225.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: AlohaCare Medicaid |
$112.50
|
| Rate for Payer: AlohaCare Medicare |
$69.75
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Devoted Health Medicare |
$76.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$213.75
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Humana Medicare |
$69.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.75
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.75
|
| Rate for Payer: University Health Alliance Commercial |
$164.00
|
|
