|
TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$33,677.33
|
|
|
Service Code
|
APR-DRG 0041
|
| Min. Negotiated Rate |
$33,677.33 |
| Max. Negotiated Rate |
$33,677.33 |
| Rate for Payer: AlohaCare Medicaid |
$33,677.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33,677.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$33,677.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33,677.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33,677.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33,677.33
|
|
|
TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$37,496.87
|
|
|
Service Code
|
APR-DRG 0042
|
| Min. Negotiated Rate |
$37,496.87 |
| Max. Negotiated Rate |
$37,496.87 |
| Rate for Payer: AlohaCare Medicaid |
$37,496.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37,496.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37,496.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37,496.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37,496.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37,496.87
|
|
|
TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$45,055.72
|
|
|
Service Code
|
APR-DRG 0054
|
| Min. Negotiated Rate |
$45,055.72 |
| Max. Negotiated Rate |
$45,055.72 |
| Rate for Payer: AlohaCare Medicaid |
$45,055.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$45,055.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45,055.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45,055.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45,055.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45,055.72
|
|
|
TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$26,914.48
|
|
|
Service Code
|
APR-DRG 0052
|
| Min. Negotiated Rate |
$26,914.48 |
| Max. Negotiated Rate |
$26,914.48 |
| Rate for Payer: AlohaCare Medicaid |
$26,914.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26,914.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26,914.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26,914.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26,914.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26,914.48
|
|
|
TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$25,205.30
|
|
|
Service Code
|
APR-DRG 0051
|
| Min. Negotiated Rate |
$25,205.30 |
| Max. Negotiated Rate |
$25,205.30 |
| Rate for Payer: AlohaCare Medicaid |
$25,205.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25,205.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25,205.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25,205.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25,205.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25,205.30
|
|
|
TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$34,684.11
|
|
|
Service Code
|
APR-DRG 0053
|
| Min. Negotiated Rate |
$34,684.11 |
| Max. Negotiated Rate |
$34,684.11 |
| Rate for Payer: AlohaCare Medicaid |
$34,684.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34,684.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$34,684.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34,684.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34,684.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34,684.11
|
|
|
TRAMADOL 50 MG PO TABLET
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$3.74
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: MDX Hawaii PPO |
$4.27
|
|
|
TRAMADOL 50 MG PO TABLET
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$3.74
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.24
|
| Rate for Payer: MDX Hawaii PPO |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.64
|
| Rate for Payer: University Health Alliance Commercial |
$3.21
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN
|
Facility
|
IP
|
$32.02
|
|
|
Service Code
|
HCPCS J3290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
| Rate for Payer: MDX Hawaii PPO |
$20.46
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN
|
Facility
|
OP
|
$41.52
|
|
|
Service Code
|
HCPCS J3290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.42
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.76
|
| Rate for Payer: MDX Hawaii PPO |
$20.46
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.21
|
| Rate for Payer: University Health Alliance Commercial |
$23.34
|
| Rate for Payer: University Health Alliance Commercial |
$15.37
|
| Rate for Payer: University Health Alliance Commercial |
$30.26
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
OP
|
$38.62
|
|
|
Service Code
|
NDC 39822100001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.69
|
| Rate for Payer: Health Management Network Commercial |
$32.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.70
|
| Rate for Payer: MDX Hawaii PPO |
$37.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.17
|
| Rate for Payer: University Health Alliance Commercial |
$28.15
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
IP
|
$21.09
|
|
|
Service Code
|
NDC 25021041510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Health Management Network Commercial |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$20.46
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
OP
|
$41.52
|
|
|
Service Code
|
NDC 81284061110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.44
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.18
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.91
|
| Rate for Payer: University Health Alliance Commercial |
$30.26
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
IP
|
$41.52
|
|
|
Service Code
|
NDC 81284061110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
OP
|
$21.09
|
|
|
Service Code
|
NDC 25021041510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.04
|
| Rate for Payer: Health Management Network Commercial |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.76
|
| Rate for Payer: MDX Hawaii PPO |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.65
|
| Rate for Payer: University Health Alliance Commercial |
$15.37
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
IP
|
$38.62
|
|
|
Service Code
|
NDC 39822100001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Health Management Network Commercial |
$32.83
|
| Rate for Payer: MDX Hawaii PPO |
$37.46
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
IP
|
$41.52
|
|
|
Service Code
|
NDC 81284061100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
OP
|
$41.52
|
|
|
Service Code
|
NDC 81284061100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.44
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.18
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.91
|
| Rate for Payer: University Health Alliance Commercial |
$30.26
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
IP
|
$32.02
|
|
|
Service Code
|
NDC 83634040141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
OP
|
$32.02
|
|
|
Service Code
|
NDC 83634040110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.42
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.33
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.21
|
| Rate for Payer: University Health Alliance Commercial |
$23.34
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
IP
|
$32.02
|
|
|
Service Code
|
NDC 83634040110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
|
|
TRANEXAMIC ACID 500 MG/5 ML TOPICAL USE
|
Facility
|
OP
|
$32.02
|
|
|
Service Code
|
NDC 83634040141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$31.06 |
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.42
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.33
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.21
|
| Rate for Payer: University Health Alliance Commercial |
$23.34
|
|
|
TRANSFERASE ALANINE AMINO ALT SGPT
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 84460
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: AlohaCare Medicaid |
$7.32
|
| Rate for Payer: AlohaCare Medicare |
$5.30
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Devoted Health Medicare |
$5.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.30
|
|
|
TRANSFERASE ASPARTATE AMINO AST SGOT
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 84450
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: AlohaCare Medicaid |
$7.14
|
| Rate for Payer: AlohaCare Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Devoted Health Medicare |
$5.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.15
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.18
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
|
OP
|
$10,679.55
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
