|
Fast Fix 360 Knot Pusher/Cutter Slot Cann 72202674 [3640458]
|
Facility
|
OP
|
$888.16
|
|
| Hospital Charge Code |
3640458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.96 |
| Max. Negotiated Rate |
$861.52 |
| Rate for Payer: Cash Price |
$577.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$843.75
|
| Rate for Payer: Health Management Network Commercial |
$754.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$452.96
|
| Rate for Payer: MDX Hawaii PPO |
$861.52
|
| Rate for Payer: University Health Alliance Commercial |
$647.38
|
|
|
Fast Fix 360 Straight Ndl Del Sys 72202467 [3645361]
|
Facility
|
IP
|
$2,922.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3645361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,636.73 |
| Max. Negotiated Rate |
$2,835.06 |
| Rate for Payer: Cash Price |
$1,899.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,045.92
|
| Rate for Payer: Health Management Network Commercial |
$2,484.33
|
| Rate for Payer: MDX Hawaii PPO |
$2,835.06
|
| Rate for Payer: University Health Alliance Commercial |
$1,636.73
|
|
|
Fast Fix 360 Straight Ndl Del Sys 72202467 [3645361]
|
Facility
|
OP
|
$2,922.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3645361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,490.60 |
| Max. Negotiated Rate |
$2,835.06 |
| Rate for Payer: Cash Price |
$1,899.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,045.92
|
| Rate for Payer: Health Management Network Commercial |
$2,484.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,841.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,490.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,835.06
|
| Rate for Payer: University Health Alliance Commercial |
$1,636.73
|
|
|
FDL Implant System 4.75mm AR-1547BC-CP [3644918]
|
Facility
|
OP
|
$10,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,214.75 |
| Max. Negotiated Rate |
$9,918.25 |
| Rate for Payer: Cash Price |
$6,646.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,157.50
|
| Rate for Payer: Health Management Network Commercial |
$8,691.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,441.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,214.75
|
| Rate for Payer: MDX Hawaii PPO |
$9,918.25
|
| Rate for Payer: University Health Alliance Commercial |
$5,726.00
|
|
|
FDL Implant System 4.75mm AR-1547BC-CP [3644918]
|
Facility
|
IP
|
$10,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3644918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,726.00 |
| Max. Negotiated Rate |
$9,918.25 |
| Rate for Payer: Cash Price |
$6,646.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,157.50
|
| Rate for Payer: Health Management Network Commercial |
$8,691.25
|
| Rate for Payer: MDX Hawaii PPO |
$9,918.25
|
| Rate for Payer: University Health Alliance Commercial |
$5,726.00
|
|
|
FELODIPINE 2.5 MG PO TAB SR 24H
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Health Management Network Commercial |
$7.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.10
|
|
|
FELODIPINE 2.5 MG PO TAB SR 24H
|
Facility
|
OP
|
$8.35
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.93
|
| Rate for Payer: Health Management Network Commercial |
$7.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.26
|
| Rate for Payer: MDX Hawaii PPO |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.01
|
| Rate for Payer: University Health Alliance Commercial |
$6.09
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$8,998.03
|
|
|
Service Code
|
APR-DRG 5314
|
| Min. Negotiated Rate |
$8,998.03 |
| Max. Negotiated Rate |
$8,998.03 |
| Rate for Payer: AlohaCare Medicaid |
$8,998.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8,998.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8,998.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8,998.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,998.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8,998.03
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$3,252.15
|
|
|
Service Code
|
APR-DRG 5312
|
| Min. Negotiated Rate |
$3,252.15 |
| Max. Negotiated Rate |
$3,252.15 |
| Rate for Payer: AlohaCare Medicaid |
$3,252.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,252.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,252.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,252.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,252.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,252.15
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$2,532.57
|
|
|
Service Code
|
APR-DRG 5311
|
| Min. Negotiated Rate |
$2,532.57 |
| Max. Negotiated Rate |
$2,532.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,532.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2,532.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,532.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,532.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,532.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,532.57
|
|
|
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
|
Facility
|
IP
|
$5,403.27
|
|
|
Service Code
|
APR-DRG 5313
|
| Min. Negotiated Rate |
$5,403.27 |
| Max. Negotiated Rate |
$5,403.27 |
| Rate for Payer: AlohaCare Medicaid |
$5,403.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5,403.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5,403.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,403.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,403.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,403.27
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$2,912.74
|
|
|
Service Code
|
APR-DRG 5301
|
| Min. Negotiated Rate |
$2,912.74 |
| Max. Negotiated Rate |
$2,912.74 |
| Rate for Payer: AlohaCare Medicaid |
$2,912.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2,912.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,912.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,912.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,912.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,912.74
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$3,657.16
|
|
|
Service Code
|
APR-DRG 5302
|
| Min. Negotiated Rate |
$3,657.16 |
| Max. Negotiated Rate |
$3,657.16 |
| Rate for Payer: AlohaCare Medicaid |
$3,657.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,657.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,657.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,657.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,657.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,657.16
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,454.20
|
|
|
Service Code
|
APR-DRG 5304
|
| Min. Negotiated Rate |
$8,454.20 |
| Max. Negotiated Rate |
$8,454.20 |
| Rate for Payer: AlohaCare Medicaid |
$8,454.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8,454.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8,454.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8,454.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,454.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8,454.20
|
|
|
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
|
Facility
|
IP
|
$5,273.37
|
|
|
Service Code
|
APR-DRG 5303
|
| Min. Negotiated Rate |
$5,273.37 |
| Max. Negotiated Rate |
$5,273.37 |
| Rate for Payer: AlohaCare Medicaid |
$5,273.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5,273.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5,273.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,273.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,273.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,273.37
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$3,989.57
|
|
|
Service Code
|
APR-DRG 5141
|
| Min. Negotiated Rate |
$3,989.57 |
| Max. Negotiated Rate |
$3,989.57 |
| Rate for Payer: AlohaCare Medicaid |
$3,989.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,989.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,989.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,989.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,989.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,989.57
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$10,698.29
|
|
|
Service Code
|
APR-DRG 5143
|
| Min. Negotiated Rate |
$10,698.29 |
| Max. Negotiated Rate |
$10,698.29 |
| Rate for Payer: AlohaCare Medicaid |
$10,698.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10,698.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10,698.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,698.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10,698.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10,698.29
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$18,753.21
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$18,753.21 |
| Max. Negotiated Rate |
$18,753.21 |
| Rate for Payer: AlohaCare Medicaid |
$18,753.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18,753.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18,753.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18,753.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18,753.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18,753.21
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$23,930.92
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$18,246.84 |
| Max. Negotiated Rate |
$23,930.92 |
| Rate for Payer: AlohaCare Medicare |
$18,246.84
|
| Rate for Payer: Devoted Health Medicare |
$20,071.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,514.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18,246.84
|
| Rate for Payer: Humana Medicare |
$18,246.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$23,930.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$18,246.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$18,246.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$18,246.84
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$5,853.49
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$5,853.49 |
| Max. Negotiated Rate |
$5,853.49 |
| Rate for Payer: AlohaCare Medicaid |
$5,853.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5,853.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5,853.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5,853.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,853.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,853.49
|
|
|
Femoral Bone Cement Prep Kit 00504905510 [3642513]
|
Facility
|
OP
|
$1,139.90
|
|
| Hospital Charge Code |
3642513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.35 |
| Max. Negotiated Rate |
$1,105.70 |
| Rate for Payer: Cash Price |
$740.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,082.90
|
| Rate for Payer: Health Management Network Commercial |
$968.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$581.35
|
| Rate for Payer: MDX Hawaii PPO |
$1,105.70
|
| Rate for Payer: University Health Alliance Commercial |
$830.87
|
|
|
Femoral Bone Cement Prep Kit 00504905510 [3642513]
|
Facility
|
IP
|
$1,139.90
|
|
| Hospital Charge Code |
3642513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.91 |
| Max. Negotiated Rate |
$1,105.70 |
| Rate for Payer: Cash Price |
$740.94
|
| Rate for Payer: Health Management Network Commercial |
$968.91
|
| Rate for Payer: MDX Hawaii PPO |
$1,105.70
|
|
|
Femoral Core 16mm 45647016 [3644411]
|
Facility
|
OP
|
$19,703.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
3644411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,048.53 |
| Max. Negotiated Rate |
$19,111.91 |
| Rate for Payer: Cash Price |
$12,806.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,792.10
|
| Rate for Payer: Health Management Network Commercial |
$16,747.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$12,412.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,048.53
|
| Rate for Payer: MDX Hawaii PPO |
$19,111.91
|
| Rate for Payer: University Health Alliance Commercial |
$11,033.68
|
|
|
Femoral Core 16mm 45647016 [3644411]
|
Facility
|
IP
|
$19,703.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
3644411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,033.68 |
| Max. Negotiated Rate |
$19,111.91 |
| Rate for Payer: Cash Price |
$12,806.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,792.10
|
| Rate for Payer: Health Management Network Commercial |
$16,747.55
|
| Rate for Payer: MDX Hawaii PPO |
$19,111.91
|
| Rate for Payer: University Health Alliance Commercial |
$11,033.68
|
|
|
Femoral Prep Kit 00504905510 [3642436]
|
Facility
|
OP
|
$1,139.90
|
|
| Hospital Charge Code |
3642436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.35 |
| Max. Negotiated Rate |
$1,105.70 |
| Rate for Payer: Cash Price |
$740.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,082.90
|
| Rate for Payer: Health Management Network Commercial |
$968.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$718.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$581.35
|
| Rate for Payer: MDX Hawaii PPO |
$1,105.70
|
| Rate for Payer: University Health Alliance Commercial |
$830.87
|
|
