|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
4501204601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
OP
|
$7,128.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
4501204701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,914.16 |
| Rate for Payer: AlohaCare Medicaid |
$3,564.00
|
| Rate for Payer: AlohaCare Medicare |
$5,417.28
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Devoted Health Medicare |
$5,987.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,417.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,771.60
|
| Rate for Payer: Health Management Network Commercial |
$6,058.80
|
| Rate for Payer: Humana Medicare |
$5,417.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,415.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,417.28
|
| Rate for Payer: MDX Hawaii PPO |
$6,914.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,417.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,417.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,417.28
|
| Rate for Payer: University Health Alliance Commercial |
$5,195.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
IP
|
$7,128.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
4501204701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,058.80 |
| Max. Negotiated Rate |
$6,914.16 |
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Health Management Network Commercial |
$6,058.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,415.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,914.16
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, TRUNK, AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
IP
|
$7,280.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
4501203701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,188.00 |
| Max. Negotiated Rate |
$7,061.60 |
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Health Management Network Commercial |
$6,188.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,552.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,061.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, TRUNK, AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
OP
|
$7,280.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
4501203701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,061.60 |
| Rate for Payer: AlohaCare Medicaid |
$3,640.00
|
| Rate for Payer: AlohaCare Medicare |
$5,532.80
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Devoted Health Medicare |
$6,115.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,532.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,916.00
|
| Rate for Payer: Health Management Network Commercial |
$6,188.00
|
| Rate for Payer: Humana Medicare |
$5,532.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,552.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,532.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,061.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,532.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,532.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,532.80
|
| Rate for Payer: University Health Alliance Commercial |
$5,306.39
|
|
|
HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
3018355001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
|
HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
3018355001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$61.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.74
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.48
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.48
|
| Rate for Payer: University Health Alliance Commercial |
$22.59
|
|
|
HC ISOLATION ROOM DAILY
|
Facility
|
IP
|
$4,200.00
|
|
| Hospital Charge Code |
1640000001
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$1,564.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Devoted Health Medicare |
$1,720.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,140.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,564.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,140.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,570.00
|
| Rate for Payer: Humana Medicare |
$1,564.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,780.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,564.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,074.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,564.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,564.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HC IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
9409636001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$1,056.33 |
| Rate for Payer: AlohaCare Medicaid |
$544.50
|
| Rate for Payer: AlohaCare Medicare |
$827.64
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Devoted Health Medicare |
$914.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$827.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,034.55
|
| Rate for Payer: Health Management Network Commercial |
$925.65
|
| Rate for Payer: Humana Medicare |
$827.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$827.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$827.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$827.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$827.64
|
| Rate for Payer: University Health Alliance Commercial |
$793.77
|
|
|
HC IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4509636001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$419.00
|
| Rate for Payer: AlohaCare Medicare |
$636.88
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Devoted Health Medicare |
$703.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$636.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$796.10
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Humana Medicare |
$636.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$636.88
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$636.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$636.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$636.88
|
| Rate for Payer: University Health Alliance Commercial |
$610.82
|
|
|
HC IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
9409636001
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$1,056.33 |
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Health Management Network Commercial |
$925.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
|
|
HC IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4509636001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
|
HC IV INFUSION, HYDRATION, EA ADD HOUR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4509636101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$139.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$154.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.80
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$139.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.84
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.84
|
| Rate for Payer: University Health Alliance Commercial |
$134.12
|
|
|
HC IV INFUSION, HYDRATION, EA ADD HOUR
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4509636101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4509636701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$141.50
|
| Rate for Payer: AlohaCare Medicare |
$215.08
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$237.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.85
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Humana Medicare |
$215.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.08
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.08
|
| Rate for Payer: University Health Alliance Commercial |
$206.28
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
4509636701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.55 |
| Max. Negotiated Rate |
$274.51 |
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
4509636801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.85 |
| Max. Negotiated Rate |
$156.17 |
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
4509636801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$80.50
|
| Rate for Payer: AlohaCare Medicare |
$122.36
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Devoted Health Medicare |
$135.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.95
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Humana Medicare |
$122.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.36
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.36
|
| Rate for Payer: University Health Alliance Commercial |
$117.35
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
4509636501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$419.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$419.00
|
| Rate for Payer: AlohaCare Medicare |
$636.88
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Devoted Health Medicare |
$703.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$636.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$796.10
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Humana Medicare |
$636.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$636.88
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$636.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$636.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$636.88
|
| Rate for Payer: University Health Alliance Commercial |
$610.82
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
4509636501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
9409636501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$1,056.33 |
| Rate for Payer: AlohaCare Medicaid |
$544.50
|
| Rate for Payer: AlohaCare Medicare |
$827.64
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Devoted Health Medicare |
$914.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$827.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,034.55
|
| Rate for Payer: Health Management Network Commercial |
$925.65
|
| Rate for Payer: Humana Medicare |
$827.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$827.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$827.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$827.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$827.64
|
| Rate for Payer: University Health Alliance Commercial |
$793.77
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
9409636501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$1,056.33 |
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Health Management Network Commercial |
$925.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
4509636601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
4509636601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$139.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$154.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.80
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$139.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.84
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.84
|
| Rate for Payer: University Health Alliance Commercial |
$134.12
|
|
|
HC KEPPRA/LEVETRACETAM (WKEPPA)
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$84.36
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$93.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$84.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.36
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.36
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
