|
DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 69000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: AlohaCare Medicaid |
$133.40
|
| Rate for Payer: AlohaCare Medicare |
$122.71
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Devoted Health Medicare |
$122.71
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$133.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$199.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$329.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.71
|
| Rate for Payer: University Health Alliance Commercial |
$170.87
|
|
|
DRAINAGE FINGER ABSCESS/FELON Charge
|
Facility
|
IP
|
$4,314.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
440260110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,666.90 |
| Max. Negotiated Rate |
$4,184.58 |
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Health Management Network Commercial |
$3,666.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,882.60
|
| Rate for Payer: MDX Hawaii PPO |
$4,184.58
|
|
|
DRAINAGE FINGER ABSCESS/FELON Charge
|
Facility
|
OP
|
$4,314.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
440260110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$4,184.58 |
| Rate for Payer: AlohaCare Medicaid |
$2,157.00
|
| Rate for Payer: AlohaCare Medicare |
$1,811.88
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$3,968.88
|
| Rate for Payer: Devoted Health Medicare |
$1,811.88
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,811.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,098.30
|
| Rate for Payer: Health Management Network Commercial |
$3,666.90
|
| Rate for Payer: Humana Medicare |
$1,811.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,882.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,811.88
|
| Rate for Payer: MDX Hawaii PPO |
$4,184.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,811.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,811.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,811.88
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
440260100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.72 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$342.72
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$750.72
|
| Rate for Payer: Devoted Health Medicare |
$342.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$342.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.72
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.72
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
|
DRAINAGE FINGER ABSCESS SIMPLE
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
440260100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
DRAIN EXTERNAL EAR LESION CHARGE
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
440690000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
DRAIN EXTERNAL EAR LESION CHARGE
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 69000
|
| Hospital Charge Code |
440690000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$342.72
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$750.72
|
| Rate for Payer: Devoted Health Medicare |
$342.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$342.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.72
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.72
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
|
DRAIN SPONGE
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
8087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.30
|
| 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
|
|
|
DRAIN SPONGE
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
8087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1.84
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.84
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.84
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
DRESS/DEBRIDE LG W/0 ANES ED Charge
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
440160300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$731.38 |
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Health Management Network Commercial |
$640.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$678.60
|
| Rate for Payer: MDX Hawaii PPO |
$731.38
|
|
|
DRESS/DEBRIDE LG W/0 ANES ED Charge
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
440160300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$377.00
|
| Rate for Payer: AlohaCare Medicare |
$316.68
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$693.68
|
| Rate for Payer: Devoted Health Medicare |
$316.68
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$716.30
|
| Rate for Payer: Health Management Network Commercial |
$640.90
|
| Rate for Payer: Humana Medicare |
$316.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$678.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.68
|
| Rate for Payer: MDX Hawaii PPO |
$731.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.68
|
| Rate for Payer: University Health Alliance Commercial |
$549.59
|
|
|
DRESS/DEBRIDE MD W/O ANES ED Charge
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
440160250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$377.00
|
| Rate for Payer: AlohaCare Medicare |
$316.68
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$693.68
|
| Rate for Payer: Devoted Health Medicare |
$316.68
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$716.30
|
| Rate for Payer: Health Management Network Commercial |
$640.90
|
| Rate for Payer: Humana Medicare |
$316.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$678.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.68
|
| Rate for Payer: MDX Hawaii PPO |
$731.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.68
|
| Rate for Payer: University Health Alliance Commercial |
$549.59
|
|
|
DRESS/DEBRIDE MD W/O ANES ED Charge
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
440160250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$731.38 |
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Health Management Network Commercial |
$640.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$678.60
|
| Rate for Payer: MDX Hawaii PPO |
$731.38
|
|
|
DRESS/DEBRIDE SM W/O ANES ED
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
440160200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$731.38 |
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Health Management Network Commercial |
$640.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$678.60
|
| Rate for Payer: MDX Hawaii PPO |
$731.38
|
|
|
DRESS/DEBRIDE SM W/O ANES ED
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
440160200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.68 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$377.00
|
| Rate for Payer: AlohaCare Medicare |
$316.68
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Cash Price |
$490.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$693.68
|
| Rate for Payer: Devoted Health Medicare |
$316.68
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$316.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$716.30
|
| Rate for Payer: Health Management Network Commercial |
$640.90
|
| Rate for Payer: Humana Medicare |
$316.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$678.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$316.68
|
| Rate for Payer: MDX Hawaii PPO |
$731.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$316.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$316.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$316.68
|
| Rate for Payer: University Health Alliance Commercial |
$549.59
|
|
|
droNABinol 10 mg Cap [KMC]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS Q0167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$18.40
|
| Rate for Payer: Devoted Health Medicare |
$8.40
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.40
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.40
|
| Rate for Payer: University Health Alliance Commercial |
$14.58
|
|
|
droNABinol 10 mg Cap [KMC]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS Q0167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
dronabinol 2.5 mg Cap [KMC]
|
Facility
|
OP
|
$8.10
|
|
|
Service Code
|
HCPCS Q0167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: AlohaCare Medicaid |
$4.05
|
| Rate for Payer: AlohaCare Medicare |
$3.40
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$7.45
|
| Rate for Payer: Devoted Health Medicare |
$3.40
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.70
|
| Rate for Payer: Health Management Network Commercial |
$6.88
|
| Rate for Payer: Humana Medicare |
$3.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.40
|
| Rate for Payer: MDX Hawaii PPO |
$7.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.40
|
| Rate for Payer: University Health Alliance Commercial |
$5.90
|
|
|
dronabinol 2.5 mg Cap [KMC]
|
Facility
|
IP
|
$8.10
|
|
|
Service Code
|
HCPCS Q0167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Health Management Network Commercial |
$6.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.29
|
| Rate for Payer: MDX Hawaii PPO |
$7.86
|
|
|
droperidol 5 mg/ 2 mL vial [KMC]
|
Facility
|
OP
|
$17.93
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: AlohaCare Medicaid |
$8.96
|
| Rate for Payer: AlohaCare Medicare |
$7.53
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$16.50
|
| Rate for Payer: Devoted Health Medicare |
$7.53
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.03
|
| Rate for Payer: Health Management Network Commercial |
$15.24
|
| Rate for Payer: Humana Medicare |
$7.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.53
|
| Rate for Payer: MDX Hawaii PPO |
$17.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.53
|
| Rate for Payer: University Health Alliance Commercial |
$13.07
|
|
|
droperidol 5 mg/ 2 mL vial [KMC]
|
Facility
|
IP
|
$17.93
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: Health Management Network Commercial |
$15.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.14
|
| Rate for Payer: MDX Hawaii PPO |
$17.39
|
|
|
DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 64640
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.91 |
| Max. Negotiated Rate |
$512.55 |
| Rate for Payer: AlohaCare Medicaid |
$122.23
|
| Rate for Payer: AlohaCare Medicare |
$113.91
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Devoted Health Medicare |
$113.91
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$122.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$113.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.26
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$113.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$113.91
|
| Rate for Payer: University Health Alliance Commercial |
$159.13
|
|
|
DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 64632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.09 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: AlohaCare Medicaid |
$68.82
|
| Rate for Payer: AlohaCare Medicare |
$63.09
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$63.09
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$68.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$104.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.09
|
| Rate for Payer: University Health Alliance Commercial |
$86.35
|
|
|
DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 90698
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$262.65 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$200.85
|
| Rate for Payer: Cash Price |
$200.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.50
|
| Rate for Payer: Health Management Network Commercial |
$262.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 90698 SL
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$89.50 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.50
|
| Rate for Payer: Health Management Network Commercial |
$0.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
