|
VCARE SMALL CUP 60-6085-200A
|
Facility
|
OP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.19 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: AlohaCare Medicaid |
$174.50
|
| Rate for Payer: AlohaCare Medicare |
$108.19
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Devoted Health Medicare |
$118.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.55
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: Humana Medicare |
$108.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$314.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.19
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.19
|
| Rate for Payer: University Health Alliance Commercial |
$254.39
|
|
|
VCARE SMALL CUP 60-6085-200A
|
Facility
|
IP
|
$349.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$296.65 |
| Max. Negotiated Rate |
$338.53 |
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Health Management Network Commercial |
$296.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$314.10
|
| Rate for Payer: MDX Hawaii PPO |
$338.53
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 55150023501
|
|
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
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 25021068510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 67457043810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.90
|
| Rate for Payer: MDX Hawaii PPO |
$20.37
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 55150023510
|
|
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
|
|
|
VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION [11634]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 47335093144
|
|
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 |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [126219]
|
Facility
|
IP
|
$11,732.00
|
|
|
Service Code
|
HCPCS J3380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9,972.20 |
| Max. Negotiated Rate |
$11,380.04 |
| Rate for Payer: Cash Price |
$7,039.20
|
| Rate for Payer: Health Management Network Commercial |
$9,972.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,558.80
|
| Rate for Payer: MDX Hawaii PPO |
$11,380.04
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION [126219]
|
Facility
|
OP
|
$11,732.00
|
|
|
Service Code
|
HCPCS J3380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$11,380.04 |
| Rate for Payer: AlohaCare Medicaid |
$5,866.00
|
| Rate for Payer: AlohaCare Medicare |
$3,636.92
|
| Rate for Payer: Cash Price |
$7,039.20
|
| Rate for Payer: Cash Price |
$7,039.20
|
| Rate for Payer: Devoted Health Medicare |
$3,988.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,636.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,145.40
|
| Rate for Payer: Health Management Network Commercial |
$9,972.20
|
| Rate for Payer: Humana Medicare |
$3,636.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,558.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,983.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,636.92
|
| Rate for Payer: MDX Hawaii PPO |
$11,380.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,636.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,636.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7,039.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,636.92
|
| Rate for Payer: University Health Alliance Commercial |
$8,551.45
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$32,898.38
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$32,898.38 |
| Max. Negotiated Rate |
$32,898.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32,898.38
|
|
|
VEIN STRIPPER
|
Facility
|
IP
|
$228.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
|
VEIN STRIPPER
|
Facility
|
OP
|
$228.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: AlohaCare Medicaid |
$114.00
|
| Rate for Payer: AlohaCare Medicare |
$70.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Devoted Health Medicare |
$77.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$216.60
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Humana Medicare |
$70.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.68
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.68
|
| Rate for Payer: University Health Alliance Commercial |
$166.19
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 23155024601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68084089625
|
|
Hospital Revenue Code
|
637
|
| 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 Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68084089625
|
|
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
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68084089695
|
|
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
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68001015700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68084089695
|
|
Hospital Revenue Code
|
637
|
| 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 Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 68001015700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: AlohaCare Medicaid |
$3.50
|
| Rate for Payer: AlohaCare Medicare |
$2.17
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$2.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Humana Medicare |
$2.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.17
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.17
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
VENLAFAXINE 25 MG TABLET [12203]
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 23155024601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: AlohaCare Medicaid |
$3.50
|
| Rate for Payer: AlohaCare Medicare |
$2.17
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Devoted Health Medicare |
$2.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.65
|
| Rate for Payer: Health Management Network Commercial |
$5.95
|
| Rate for Payer: Humana Medicare |
$2.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.17
|
| Rate for Payer: MDX Hawaii PPO |
$6.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.17
|
| Rate for Payer: University Health Alliance Commercial |
$5.10
|
|
|
VENLAFAXINE 75 MG TABLET [12206]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68001016000
|
|
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
|
|
|
VENLAFAXINE 75 MG TABLET [12206]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
NDC 68001016000
|
|
Hospital Revenue Code
|
637
|
| 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 Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [27859]
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
NDC 68084071301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: AlohaCare Medicaid |
$8.50
|
| Rate for Payer: AlohaCare Medicare |
$5.27
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$5.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Humana Medicare |
$5.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.27
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.27
|
| Rate for Payer: University Health Alliance Commercial |
$12.39
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [27859]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 65862069730
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$5.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.58
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [27859]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 65862069730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
