|
Fetal Contraction Stress Test
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
8141335
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: AlohaCare Medicaid |
$220.00
|
| Rate for Payer: AlohaCare Medicare |
$220.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Devoted Health Medicare |
$242.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$418.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Humana Medicare |
$220.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$220.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$320.72
|
|
|
Fetal Contraction Stress Test
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
8141335
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
|
|
Fetal Contraction Stress Test
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
8141336
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: AlohaCare Medicaid |
$220.00
|
| Rate for Payer: AlohaCare Medicare |
$220.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Devoted Health Medicare |
$242.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$418.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Humana Medicare |
$220.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$220.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$320.72
|
|
|
Fetal Contraction Stress Test
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 59020
|
| Hospital Charge Code |
8141336
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
|
|
Fetal Fibronectin Screen FSI
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
8117910
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$765.00 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Health Management Network Commercial |
$765.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.00
|
| Rate for Payer: MDX Hawaii PPO |
$873.00
|
|
|
Fetal Fibronectin Screen FSI
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
8117910
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: AlohaCare Medicaid |
$450.00
|
| Rate for Payer: AlohaCare Medicare |
$450.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Devoted Health Medicare |
$495.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$450.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$239.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.41
|
| Rate for Payer: Health Management Network Commercial |
$765.00
|
| Rate for Payer: Humana Medicare |
$450.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$450.00
|
| Rate for Payer: MDX Hawaii PPO |
$873.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$450.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$450.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$450.00
|
| Rate for Payer: University Health Alliance Commercial |
$166.48
|
|
|
Fetal Non-Stress Test
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
8074275
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$723.35 |
| Max. Negotiated Rate |
$825.47 |
| Rate for Payer: Cash Price |
$553.15
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$765.90
|
| Rate for Payer: MDX Hawaii PPO |
$825.47
|
|
|
Fetal Non-Stress Test
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
8074275
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$825.47 |
| Rate for Payer: AlohaCare Medicaid |
$425.50
|
| Rate for Payer: AlohaCare Medicare |
$425.50
|
| Rate for Payer: Cash Price |
$553.15
|
| Rate for Payer: Cash Price |
$553.15
|
| Rate for Payer: Devoted Health Medicare |
$468.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$258.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$425.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$808.45
|
| Rate for Payer: Health Management Network Commercial |
$723.35
|
| Rate for Payer: Humana Medicare |
$425.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$765.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$425.50
|
| Rate for Payer: MDX Hawaii PPO |
$825.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$425.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$425.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$425.50
|
| Rate for Payer: University Health Alliance Commercial |
$620.29
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$24,272.19
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$24,272.19 |
| Max. Negotiated Rate |
$24,272.19 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24,272.19
|
|
|
FFP 1 Unit FSI
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11641971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
|
|
FFP 1 Unit FSI
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11641971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: AlohaCare Medicaid |
$169.50
|
| Rate for Payer: AlohaCare Medicare |
$169.50
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Devoted Health Medicare |
$186.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Humana Medicare |
$169.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.50
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.50
|
| Rate for Payer: University Health Alliance Commercial |
$247.10
|
|
|
FFP 2 Units FSI
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11640498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: AlohaCare Medicaid |
$169.50
|
| Rate for Payer: AlohaCare Medicare |
$169.50
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Devoted Health Medicare |
$186.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Humana Medicare |
$169.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.50
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.50
|
| Rate for Payer: University Health Alliance Commercial |
$247.10
|
|
|
FFP 2 Units FSI
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11640498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
|
|
FFP 3 Units FSI
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11641972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
|
|
FFP 3 Units FSI
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11641972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: AlohaCare Medicaid |
$169.50
|
| Rate for Payer: AlohaCare Medicare |
$169.50
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Devoted Health Medicare |
$186.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Humana Medicare |
$169.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.50
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.50
|
| Rate for Payer: University Health Alliance Commercial |
$247.10
|
|
|
FFP 4 Units FSI
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11641973
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$288.15 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
|
|
FFP 4 Units FSI
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
11641973
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$328.83 |
| Rate for Payer: AlohaCare Medicaid |
$169.50
|
| Rate for Payer: AlohaCare Medicare |
$169.50
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Cash Price |
$220.35
|
| Rate for Payer: Devoted Health Medicare |
$186.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$169.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$288.15
|
| Rate for Payer: Humana Medicare |
$169.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$172.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$169.50
|
| Rate for Payer: MDX Hawaii PPO |
$328.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$169.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$169.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$169.50
|
| Rate for Payer: University Health Alliance Commercial |
$247.10
|
|
|
Fibrin Degradation Products FDP FSI
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 85362
|
| Hospital Charge Code |
8228867
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
Fibrin Degradation Products FDP FSI
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 85362
|
| Hospital Charge Code |
8228867
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$48.50
|
| Rate for Payer: AlohaCare Medicare |
$48.50
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Devoted Health Medicare |
$53.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$48.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.50
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.50
|
| Rate for Payer: University Health Alliance Commercial |
$17.80
|
|
|
Fibrinogen FSI
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
8117911
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Devoted Health Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$21.96
|
|
|
Fibrinogen FSI
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
8117911
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
finasteride 5 mg tablet [HHSC]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
2500326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicaid |
$9.26
|
| Rate for Payer: AlohaCare Medicaid |
$8.69
|
| Rate for Payer: AlohaCare Medicaid |
$8.70
|
| Rate for Payer: AlohaCare Medicaid |
$2.67
|
| Rate for Payer: AlohaCare Medicare |
$8.70
|
| Rate for Payer: AlohaCare Medicare |
$9.26
|
| Rate for Payer: AlohaCare Medicare |
$8.69
|
| Rate for Payer: AlohaCare Medicare |
$2.67
|
| Rate for Payer: AlohaCare Medicare |
$3.00
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Devoted Health Medicare |
$9.57
|
| Rate for Payer: Devoted Health Medicare |
$10.19
|
| Rate for Payer: Devoted Health Medicare |
$3.30
|
| Rate for Payer: Devoted Health Medicare |
$2.94
|
| Rate for Payer: Devoted Health Medicare |
$9.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.07
|
| Rate for Payer: Health Management Network Commercial |
$4.54
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$15.74
|
| Rate for Payer: Health Management Network Commercial |
$14.77
|
| Rate for Payer: Health Management Network Commercial |
$14.79
|
| Rate for Payer: Humana Medicare |
$9.26
|
| Rate for Payer: Humana Medicare |
$8.69
|
| Rate for Payer: Humana Medicare |
$2.67
|
| Rate for Payer: Humana Medicare |
$3.00
|
| Rate for Payer: Humana Medicare |
$8.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.00
|
| Rate for Payer: MDX Hawaii PPO |
$16.88
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$17.96
|
| Rate for Payer: MDX Hawaii PPO |
$16.86
|
| Rate for Payer: MDX Hawaii PPO |
$5.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.69
|
| Rate for Payer: University Health Alliance Commercial |
$12.68
|
| Rate for Payer: University Health Alliance Commercial |
$3.89
|
| Rate for Payer: University Health Alliance Commercial |
$12.67
|
| Rate for Payer: University Health Alliance Commercial |
$13.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
finasteride 5 mg tablet [HHSC]
|
Facility
|
IP
|
$5.34
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
2500326
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cash Price |
$11.31
|
| Rate for Payer: Health Management Network Commercial |
$15.74
|
| Rate for Payer: Health Management Network Commercial |
$4.54
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$14.79
|
| Rate for Payer: Health Management Network Commercial |
$14.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.18
|
| Rate for Payer: MDX Hawaii PPO |
$16.88
|
| Rate for Payer: MDX Hawaii PPO |
$16.86
|
| Rate for Payer: MDX Hawaii PPO |
$17.96
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (DIP + PIP extension; L)
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
13358970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$136.50
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$189.15
|
| Rate for Payer: University Health Alliance Commercial |
$109.20
|
|
|
Finger Orthosis, DIP, PIP, Joint/spring, Prefab, OTS (DIP + PIP extension; L)
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
13358970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.93 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: AlohaCare Medicaid |
$97.50
|
| Rate for Payer: AlohaCare Medicare |
$97.50
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Devoted Health Medicare |
$107.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$136.50
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Humana Medicare |
$97.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.50
|
| Rate for Payer: MDX Hawaii PPO |
$189.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.50
|
| Rate for Payer: University Health Alliance Commercial |
$109.20
|
|
