|
TRACH VALVE PURPLE SPEAKING
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS L8501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.71 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$91.14
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$99.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$91.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.14
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: University Health Alliance Commercial |
$164.64
|
|
|
TRACH VALVE PURPLE SPEAKING
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS L8501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$205.80
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: University Health Alliance Commercial |
$164.64
|
|
|
TRACH VALVE SPEAKING
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS L8501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$192.06 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.20
|
| Rate for Payer: MDX Hawaii PPO |
$192.06
|
| Rate for Payer: University Health Alliance Commercial |
$110.88
|
|
|
TRACH VALVE SPEAKING
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS L8501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$192.06 |
| Rate for Payer: AlohaCare Medicaid |
$99.00
|
| Rate for Payer: AlohaCare Medicare |
$61.38
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$67.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Humana Medicare |
$61.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.38
|
| Rate for Payer: MDX Hawaii PPO |
$192.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.38
|
| Rate for Payer: University Health Alliance Commercial |
$110.88
|
|
|
TRACH VALVE SPEAKING SHILEY
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS L8501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$192.06 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.20
|
| Rate for Payer: MDX Hawaii PPO |
$192.06
|
| Rate for Payer: University Health Alliance Commercial |
$110.88
|
|
|
TRACH VALVE SPEAKING SHILEY
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS L8501
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$192.06 |
| Rate for Payer: AlohaCare Medicaid |
$99.00
|
| Rate for Payer: AlohaCare Medicare |
$61.38
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Devoted Health Medicare |
$67.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.60
|
| Rate for Payer: Health Management Network Commercial |
$168.30
|
| Rate for Payer: Humana Medicare |
$61.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.38
|
| Rate for Payer: MDX Hawaii PPO |
$192.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.38
|
| Rate for Payer: University Health Alliance Commercial |
$110.88
|
|
|
TRAMADOL 50 MG TABLET [14632]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60219234801
|
|
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
|
|
|
TRAMADOL 50 MG TABLET [14632]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687079501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
TRAMADOL 50 MG TABLET [14632]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687079511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
TRAMADOL 50 MG TABLET [14632]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687079501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
TRAMADOL 50 MG TABLET [14632]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60219234801
|
|
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
|
|
|
TRAMADOL 50 MG TABLET [14632]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687079511
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
NDC 51754010801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$19.53
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$21.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.85
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$19.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.53
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.53
|
| Rate for Payer: University Health Alliance Commercial |
$45.92
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: AlohaCare Medicaid |
$31.00
|
| Rate for Payer: AlohaCare Medicare |
$19.22
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Devoted Health Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.90
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Humana Medicare |
$19.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.22
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.22
|
| Rate for Payer: University Health Alliance Commercial |
$45.19
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
|
|
TRANEXAMIC ACID 1,000 MG/100 ML(10 MG/ML)IN SOD CHLOR,ISO IV PIGGYBACK [169190]
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
NDC 51754010801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 81284061200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Devoted Health Medicare |
$2.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.48
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$6.20
|
| Rate for Payer: AlohaCare Medicare |
$19.53
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: AlohaCare Medicare |
$7.13
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$7.82
|
| Rate for Payer: Devoted Health Medicare |
$5.44
|
| Rate for Payer: Devoted Health Medicare |
$6.80
|
| Rate for Payer: Devoted Health Medicare |
$21.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.85
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$19.53
|
| Rate for Payer: Humana Medicare |
$6.20
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Humana Medicare |
$7.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.20
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
| Rate for Payer: University Health Alliance Commercial |
$45.92
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
| Rate for Payer: University Health Alliance Commercial |
$14.58
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 81284061100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$6.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$6.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$6.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.20
|
| Rate for Payer: University Health Alliance Commercial |
$14.58
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 81284061100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION [131620]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 81284061200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
TRANSCAROTID 10X40 SR-1040-CS
|
Facility
|
IP
|
$8,990.00
|
|
|
Service Code
|
HCPCS C1876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.40 |
| Max. Negotiated Rate |
$8,720.30 |
| Rate for Payer: Cash Price |
$5,394.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,293.00
|
| Rate for Payer: Health Management Network Commercial |
$7,641.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,091.00
|
| Rate for Payer: MDX Hawaii PPO |
$8,720.30
|
| Rate for Payer: University Health Alliance Commercial |
$5,034.40
|
|
|
TRANSCAROTID 10X40 SR-1040-CS
|
Facility
|
OP
|
$8,990.00
|
|
|
Service Code
|
HCPCS C1876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,786.90 |
| Max. Negotiated Rate |
$8,720.30 |
| Rate for Payer: AlohaCare Medicaid |
$4,495.00
|
| Rate for Payer: AlohaCare Medicare |
$2,786.90
|
| Rate for Payer: Cash Price |
$5,394.00
|
| Rate for Payer: Devoted Health Medicare |
$3,056.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,786.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,293.00
|
| Rate for Payer: Health Management Network Commercial |
$7,641.50
|
| Rate for Payer: Humana Medicare |
$2,786.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,091.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,584.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,786.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,720.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,786.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,786.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,786.90
|
| Rate for Payer: University Health Alliance Commercial |
$5,034.40
|
|
|
TRANSCAROTID 8X40 SR-0840-CS
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,780.00
|
| Rate for Payer: Health Management Network Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,860.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,238.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,024.00
|
|
