|
HALOPERIDOL 1 MG TABLET [3579]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079073420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
HALOPERIDOL 1 MG TABLET [3579]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 51079073420
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$1.52
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$1.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.52
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.52
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
HALOPERIDOL 1 MG TABLET [3579]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 00378025701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$1.52
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$1.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.52
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.52
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
HALOPERIDOL 1 MG TABLET [3579]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904739061
|
|
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
|
|
|
HALOPERIDOL 1 MG TABLET [3579]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 00378025701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687016101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$3.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.04
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687016111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687016111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$3.04
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$3.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.04
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.04
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
HALOPERIDOL 5 MG TABLET [3583]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687016101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS J1631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: AlohaCare Medicaid |
$39.50
|
| Rate for Payer: AlohaCare Medicare |
$60.04
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Devoted Health Medicare |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.05
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Humana Medicare |
$60.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.04
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.04
|
| Rate for Payer: University Health Alliance Commercial |
$57.58
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS J1631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
NDC 00121058104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$82.84
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$91.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.55
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$82.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.84
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.84
|
| Rate for Payer: University Health Alliance Commercial |
$79.45
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
NDC 00121058104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS J1630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: AlohaCare Medicaid |
$11.00
|
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$4.56
|
| Rate for Payer: AlohaCare Medicare |
$16.72
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Devoted Health Medicare |
$5.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Humana Medicare |
$16.72
|
| Rate for Payer: Humana Medicare |
$4.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.56
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.56
|
| Rate for Payer: University Health Alliance Commercial |
$16.04
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS J1630
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
|
|
HANDLE SHORT EGIA NEXT GEN
|
Facility
|
IP
|
$384.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Management Network Commercial |
$326.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.60
|
| Rate for Payer: MDX Hawaii PPO |
$372.48
|
|
|
HANDLE SHORT EGIA NEXT GEN
|
Facility
|
OP
|
$384.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: AlohaCare Medicaid |
$192.00
|
| Rate for Payer: AlohaCare Medicare |
$291.84
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Devoted Health Medicare |
$322.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$364.80
|
| Rate for Payer: Health Management Network Commercial |
$326.40
|
| Rate for Payer: Humana Medicare |
$291.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$195.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.84
|
| Rate for Payer: MDX Hawaii PPO |
$372.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.84
|
| Rate for Payer: University Health Alliance Commercial |
$279.90
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$26,641.05
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$26,641.05 |
| Max. Negotiated Rate |
$26,641.05 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26,641.05
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,416.45
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$18,416.45 |
| Max. Negotiated Rate |
$18,416.45 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,416.45
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$22,161.37
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$22,161.37 |
| Max. Negotiated Rate |
$22,161.37 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,161.37
|
|
|
HAND REST ORHTOSIS LEFT REG
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$203.68
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$225.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$203.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.68
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.68
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS LEFT REG
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS LEFT SM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS LEFT SM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$203.68
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$225.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$203.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.68
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.68
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT REG
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
