|
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 |
$259.78 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$419.00
|
| Rate for Payer: AlohaCare Medicare |
$259.78
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Devoted Health Medicare |
$284.92
|
| 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 |
$259.78
|
| 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 |
$259.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.78
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.78
|
| Rate for Payer: University Health Alliance Commercial |
$610.82
|
|
|
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, HYDRATION, EA ADD HOUR
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4509636101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$57.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$62.56
|
| 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 |
$57.04
|
| 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 |
$57.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.04
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.04
|
| Rate for Payer: University Health Alliance Commercial |
$134.12
|
|
|
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 |
$87.73 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$141.50
|
| Rate for Payer: AlohaCare Medicare |
$87.73
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$96.22
|
| 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 |
$87.73
|
| 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 |
$87.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.73
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.73
|
| 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 |
$49.91 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$80.50
|
| Rate for Payer: AlohaCare Medicare |
$49.91
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Devoted Health Medicare |
$54.74
|
| 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 |
$49.91
|
| 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 |
$49.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.91
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.91
|
| Rate for Payer: University Health Alliance Commercial |
$117.35
|
|
|
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 |
$337.59
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Cash Price |
$653.40
|
| Rate for Payer: Devoted Health Medicare |
$370.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$337.59
|
| 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 |
$337.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$980.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$555.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$337.59
|
| Rate for Payer: MDX Hawaii PPO |
$1,056.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$337.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$337.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$337.59
|
| 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,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
|
$838.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
4509636501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.78 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$419.00
|
| Rate for Payer: AlohaCare Medicare |
$259.78
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Devoted Health Medicare |
$284.92
|
| 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 |
$259.78
|
| 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 |
$259.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.78
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.78
|
| Rate for Payer: University Health Alliance Commercial |
$610.82
|
|
|
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 |
$57.04 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$57.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$62.56
|
| 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 |
$57.04
|
| 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 |
$57.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.04
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.04
|
| Rate for Payer: University Health Alliance Commercial |
$134.12
|
|
|
HC KAU ICF SWING ROOM DAILY
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
1210000002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| 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 |
$9,999.00
|
| 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 |
$1,190.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,260.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,358.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HC KAU SNF ROOM DAILY
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
1200000002
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$890.00 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$6,253.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
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 |
$34.41
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$37.74
|
| 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 |
$34.41
|
| 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 |
$34.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.41
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.41
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HC KEPPRA/LEVETRACETAM (WKEPPA)
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LDH
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: AlohaCare Medicaid |
$25.50
|
| Rate for Payer: AlohaCare Medicare |
$15.81
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Devoted Health Medicare |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Humana Medicare |
$15.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.81
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.81
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LDH
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LDH BODY FLUID
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: AlohaCare Medicaid |
$25.50
|
| Rate for Payer: AlohaCare Medicare |
$15.81
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Devoted Health Medicare |
$17.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Humana Medicare |
$15.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.81
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.81
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LDH BODY FLUID
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
3018361502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
|
|
HC LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$6,863.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
4503153001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,833.55 |
| Max. Negotiated Rate |
$6,657.11 |
| Rate for Payer: Cash Price |
$4,117.80
|
| Rate for Payer: Health Management Network Commercial |
$5,833.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,176.70
|
| Rate for Payer: MDX Hawaii PPO |
$6,657.11
|
|
|
HC LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$6,863.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
4503153001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,657.11 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.50
|
| Rate for Payer: AlohaCare Medicare |
$2,127.53
|
| Rate for Payer: Cash Price |
$4,117.80
|
| Rate for Payer: Cash Price |
$4,117.80
|
| Rate for Payer: Devoted Health Medicare |
$2,333.42
|
| 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 |
$2,127.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,519.85
|
| Rate for Payer: Health Management Network Commercial |
$5,833.55
|
| Rate for Payer: Humana Medicare |
$2,127.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,176.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,127.53
|
| Rate for Payer: MDX Hawaii PPO |
$6,657.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,127.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,127.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,127.53
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC LARYNGOSCOPY, DIRECT, WITH FOREIGN BODY REMOVAL; CHILD UNDER 5 YEARS
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
HCPCS 31511
|
| Hospital Charge Code |
4503151101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.36 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$378.00
|
| Rate for Payer: AlohaCare Medicare |
$234.36
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Devoted Health Medicare |
$257.04
|
| 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 |
$234.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$718.20
|
| Rate for Payer: Health Management Network Commercial |
$642.60
|
| Rate for Payer: Humana Medicare |
$234.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$680.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.36
|
| Rate for Payer: MDX Hawaii PPO |
$733.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.36
|
| Rate for Payer: University Health Alliance Commercial |
$551.05
|
|
|
HC LARYNGOSCOPY, DIRECT, WITH FOREIGN BODY REMOVAL; CHILD UNDER 5 YEARS
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
HCPCS 31511
|
| Hospital Charge Code |
4503151101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$642.60 |
| Max. Negotiated Rate |
$733.32 |
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Health Management Network Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$680.40
|
| Rate for Payer: MDX Hawaii PPO |
$733.32
|
|
