|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$24.35
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: AlohaCare Medicaid |
$12.18
|
| Rate for Payer: AlohaCare Medicare |
$12.18
|
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Devoted Health Medicare |
$13.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.13
|
| Rate for Payer: Health Management Network Commercial |
$20.70
|
| Rate for Payer: Humana Medicare |
$12.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.18
|
| Rate for Payer: MDX Hawaii PPO |
$23.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.18
|
| Rate for Payer: University Health Alliance Commercial |
$17.75
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$24.35
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Cash Price |
$15.83
|
| Rate for Payer: Health Management Network Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.91
|
| Rate for Payer: MDX Hawaii PPO |
$23.62
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$24.80
|
|
|
Service Code
|
NDC 00409318910
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$24.06 |
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Health Management Network Commercial |
$21.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.32
|
| Rate for Payer: MDX Hawaii PPO |
$24.06
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$24.80
|
|
|
Service Code
|
NDC 00409318910
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$24.06 |
| Rate for Payer: AlohaCare Medicaid |
$12.40
|
| Rate for Payer: AlohaCare Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Devoted Health Medicare |
$13.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.56
|
| Rate for Payer: Health Management Network Commercial |
$21.08
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.40
|
| Rate for Payer: MDX Hawaii PPO |
$24.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.40
|
| Rate for Payer: University Health Alliance Commercial |
$18.08
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$29.62
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.18 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Health Management Network Commercial |
$25.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.66
|
| Rate for Payer: MDX Hawaii PPO |
$28.73
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$39.70
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Health Management Network Commercial |
$33.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.73
|
| Rate for Payer: MDX Hawaii PPO |
$38.51
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$39.70
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.85 |
| Max. Negotiated Rate |
$38.51 |
| Rate for Payer: AlohaCare Medicaid |
$19.85
|
| Rate for Payer: AlohaCare Medicare |
$19.85
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Devoted Health Medicare |
$21.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.72
|
| Rate for Payer: Health Management Network Commercial |
$33.74
|
| Rate for Payer: Humana Medicare |
$19.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.85
|
| Rate for Payer: MDX Hawaii PPO |
$38.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.85
|
| Rate for Payer: University Health Alliance Commercial |
$28.94
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$24.60
|
|
|
Service Code
|
NDC 00409140310
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$23.86 |
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Health Management Network Commercial |
$20.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.14
|
| Rate for Payer: MDX Hawaii PPO |
$23.86
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$24.60
|
|
|
Service Code
|
NDC 00409140310
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$23.86 |
| Rate for Payer: AlohaCare Medicaid |
$12.30
|
| Rate for Payer: AlohaCare Medicare |
$12.30
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Devoted Health Medicare |
$13.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.37
|
| Rate for Payer: Health Management Network Commercial |
$20.91
|
| Rate for Payer: Humana Medicare |
$12.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.30
|
| Rate for Payer: MDX Hawaii PPO |
$23.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.30
|
| Rate for Payer: University Health Alliance Commercial |
$17.93
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$100.35
|
|
|
Service Code
|
NDC 71839014110
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$97.34 |
| Rate for Payer: AlohaCare Medicaid |
$50.17
|
| Rate for Payer: AlohaCare Medicare |
$50.17
|
| Rate for Payer: Cash Price |
$65.23
|
| Rate for Payer: Devoted Health Medicare |
$55.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.33
|
| Rate for Payer: Health Management Network Commercial |
$85.30
|
| Rate for Payer: Humana Medicare |
$50.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.17
|
| Rate for Payer: MDX Hawaii PPO |
$97.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.17
|
| Rate for Payer: University Health Alliance Commercial |
$73.15
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$100.35
|
|
|
Service Code
|
NDC 71839014110
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.30 |
| Max. Negotiated Rate |
$97.34 |
| Rate for Payer: Cash Price |
$65.23
|
| Rate for Payer: Health Management Network Commercial |
$85.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.31
|
| Rate for Payer: MDX Hawaii PPO |
$97.34
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$60.82
|
|
|
Service Code
|
NDC 55150022505
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: AlohaCare Medicaid |
$30.41
|
| Rate for Payer: AlohaCare Medicare |
$30.41
|
| Rate for Payer: Cash Price |
$39.53
|
| Rate for Payer: Devoted Health Medicare |
$33.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.78
|
| Rate for Payer: Health Management Network Commercial |
$51.70
|
| Rate for Payer: Humana Medicare |
$30.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.41
|
| Rate for Payer: MDX Hawaii PPO |
$59.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.41
|
| Rate for Payer: University Health Alliance Commercial |
$44.33
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$60.82
|
|
|
Service Code
|
NDC 55150022505
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Cash Price |
$39.53
|
| Rate for Payer: Health Management Network Commercial |
$51.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.74
|
| Rate for Payer: MDX Hawaii PPO |
$59.00
|
|
|
rocuronium 50 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$29.62
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
2500733
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: AlohaCare Medicaid |
$14.81
|
| Rate for Payer: AlohaCare Medicare |
$14.81
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Devoted Health Medicare |
$16.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.14
|
| Rate for Payer: Health Management Network Commercial |
$25.18
|
| Rate for Payer: Humana Medicare |
$14.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.81
|
| Rate for Payer: MDX Hawaii PPO |
$28.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.81
|
| Rate for Payer: University Health Alliance Commercial |
$21.59
|
|
|
ROM Each Extremity/Trunk Charges
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 95851 GO
|
| Hospital Charge Code |
8123865
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
ROM Each Extremity/Trunk Charges
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 95851 GO
|
| Hospital Charge Code |
8123865
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$55.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$50.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.00
|
| Rate for Payer: University Health Alliance Commercial |
$56.00
|
|
|
ROM Hand Charges
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 95852 GO
|
| Hospital Charge Code |
8123864
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.50
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
|
|
ROM Hand Charges
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 95852 GO
|
| Hospital Charge Code |
8123864
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: AlohaCare Medicaid |
$32.50
|
| Rate for Payer: AlohaCare Medicare |
$32.50
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$35.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.75
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Humana Medicare |
$32.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.50
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.50
|
| Rate for Payer: University Health Alliance Commercial |
$36.40
|
|
|
ROOM/BED: ICU
|
Facility
|
IP
|
$8,090.00
|
|
| Hospital Charge Code |
2120844
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$12,050.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$5,258.50
|
| Rate for Payer: Cash Price |
$5,258.50
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,050.00
|
| Rate for Payer: Health Management Network Commercial |
$6,876.50
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,281.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,847.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$6,369.00
|
|
|
ROOM/BED: Isolation
|
Facility
|
IP
|
$4,620.00
|
|
| Hospital Charge Code |
8163853
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$3,003.00
|
| Rate for Payer: Cash Price |
$3,003.00
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,927.00
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,158.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,481.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Isolation Swing/SNF
|
Facility
|
IP
|
$3,500.00
|
|
| Hospital Charge Code |
8163853
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$5,923.00 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$2,801.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Devoted Health Medicare |
$3,081.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,801.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$2,975.00
|
| Rate for Payer: Humana Medicare |
$2,801.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,150.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,801.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,395.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,801.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,801.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Nursery Level 1
|
Facility
|
IP
|
$2,525.00
|
|
| Hospital Charge Code |
2120838
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,098.25 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$1,641.25
|
| Rate for Payer: Cash Price |
$1,641.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,146.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,272.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,449.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,875.00
|
|
|
ROOM/BED: Nursery Level 2
|
Facility
|
IP
|
$4,525.00
|
|
| Hospital Charge Code |
4232587
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$4,389.25 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,941.25
|
| Rate for Payer: Cash Price |
$2,941.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,846.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,072.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,389.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,875.00
|
|
|
ROOM/BED: Nursery Level 3
|
Facility
|
IP
|
$7,525.00
|
|
| Hospital Charge Code |
4232588
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$7,299.25 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$4,891.25
|
| Rate for Payer: Cash Price |
$4,891.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,250.00
|
| Rate for Payer: Health Management Network Commercial |
$6,396.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,772.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,299.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,875.00
|
|
|
ROOM/BED: Nursery Level 4
|
Facility
|
IP
|
$7,725.00
|
|
| Hospital Charge Code |
4232589
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$7,493.25 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$5,021.25
|
| Rate for Payer: Cash Price |
$5,021.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,250.00
|
| Rate for Payer: Health Management Network Commercial |
$6,566.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,952.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,493.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,875.00
|
|
