|
oxytocin 10 unit/1 ml vial [HHSC]
|
Facility
|
OP
|
$24.02
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2500627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$23.30 |
| Rate for Payer: AlohaCare Medicaid |
$12.01
|
| Rate for Payer: AlohaCare Medicaid |
$4.97
|
| Rate for Payer: AlohaCare Medicaid |
$10.01
|
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$10.01
|
| Rate for Payer: AlohaCare Medicare |
$12.01
|
| Rate for Payer: AlohaCare Medicare |
$4.97
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Devoted Health Medicare |
$11.01
|
| Rate for Payer: Devoted Health Medicare |
$13.21
|
| Rate for Payer: Devoted Health Medicare |
$5.51
|
| Rate for Payer: Devoted Health Medicare |
$5.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$8.45
|
| Rate for Payer: Health Management Network Commercial |
$17.02
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Health Management Network Commercial |
$20.42
|
| Rate for Payer: Humana Medicare |
$10.01
|
| Rate for Payer: Humana Medicare |
$5.00
|
| Rate for Payer: Humana Medicare |
$12.01
|
| Rate for Payer: Humana Medicare |
$4.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.64
|
| Rate for Payer: MDX Hawaii PPO |
$23.30
|
| Rate for Payer: MDX Hawaii PPO |
$19.42
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.00
|
| Rate for Payer: University Health Alliance Commercial |
$7.25
|
| Rate for Payer: University Health Alliance Commercial |
$17.51
|
| Rate for Payer: University Health Alliance Commercial |
$7.30
|
| Rate for Payer: University Health Alliance Commercial |
$14.59
|
|
|
oxytocin 30 units/500 mL NS premix [HHSC]
|
Facility
|
OP
|
$66.85
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2500892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$64.84 |
| Rate for Payer: AlohaCare Medicaid |
$33.42
|
| Rate for Payer: AlohaCare Medicaid |
$36.87
|
| Rate for Payer: AlohaCare Medicaid |
$50.15
|
| Rate for Payer: AlohaCare Medicare |
$36.87
|
| Rate for Payer: AlohaCare Medicare |
$50.15
|
| Rate for Payer: AlohaCare Medicare |
$33.42
|
| Rate for Payer: Cash Price |
$65.19
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cash Price |
$65.19
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Devoted Health Medicare |
$40.56
|
| Rate for Payer: Devoted Health Medicare |
$36.77
|
| Rate for Payer: Devoted Health Medicare |
$55.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.51
|
| Rate for Payer: Health Management Network Commercial |
$85.25
|
| Rate for Payer: Health Management Network Commercial |
$56.82
|
| Rate for Payer: Health Management Network Commercial |
$62.68
|
| Rate for Payer: Humana Medicare |
$33.42
|
| Rate for Payer: Humana Medicare |
$50.15
|
| Rate for Payer: Humana Medicare |
$36.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.87
|
| Rate for Payer: MDX Hawaii PPO |
$71.53
|
| Rate for Payer: MDX Hawaii PPO |
$97.28
|
| Rate for Payer: MDX Hawaii PPO |
$64.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.42
|
| Rate for Payer: University Health Alliance Commercial |
$53.75
|
| Rate for Payer: University Health Alliance Commercial |
$48.73
|
| Rate for Payer: University Health Alliance Commercial |
$73.10
|
|
|
oxytocin 30 units/500 mL NS premix [HHSC]
|
Facility
|
IP
|
$66.85
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2500892
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$64.84 |
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cash Price |
$65.19
|
| Rate for Payer: Cash Price |
$47.93
|
| Rate for Payer: Health Management Network Commercial |
$62.68
|
| Rate for Payer: Health Management Network Commercial |
$85.25
|
| Rate for Payer: Health Management Network Commercial |
$56.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.16
|
| Rate for Payer: MDX Hawaii PPO |
$64.84
|
| Rate for Payer: MDX Hawaii PPO |
$97.28
|
| Rate for Payer: MDX Hawaii PPO |
$71.53
|
|
|
P9012 Cryoprecipitate Ea Unit
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
8258886
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.10
|
| Rate for Payer: MDX Hawaii PPO |
$222.13
|
|
|
P9012 Cryoprecipitate Ea Unit
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
8258886
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: AlohaCare Medicaid |
$114.50
|
| Rate for Payer: AlohaCare Medicare |
$114.50
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Devoted Health Medicare |
$125.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.55
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Humana Medicare |
$114.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.50
|
| Rate for Payer: MDX Hawaii PPO |
$222.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.50
|
| Rate for Payer: University Health Alliance Commercial |
$166.92
|
|
|
P9012 Cryoprecipitate Ea Unit [HHSC]
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
13369155
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.10
|
| Rate for Payer: MDX Hawaii PPO |
$222.13
|
|
|
P9012 Cryoprecipitate Ea Unit [HHSC]
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
13369155
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$47.68 |
| Max. Negotiated Rate |
$222.13 |
| Rate for Payer: AlohaCare Medicaid |
$114.50
|
| Rate for Payer: AlohaCare Medicare |
$114.50
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Devoted Health Medicare |
$125.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$89.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.55
|
| Rate for Payer: Health Management Network Commercial |
$194.65
|
| Rate for Payer: Humana Medicare |
$114.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.50
|
| Rate for Payer: MDX Hawaii PPO |
$222.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.50
|
| Rate for Payer: University Health Alliance Commercial |
$166.92
|
|
|
P9016 PACKED CELLS
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8258887
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$677.45 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: Cash Price |
$518.05
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$717.30
|
| Rate for Payer: MDX Hawaii PPO |
$773.09
|
|
|
P9016 PACKED CELLS
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8258887
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: AlohaCare Medicaid |
$398.50
|
| Rate for Payer: AlohaCare Medicare |
$398.50
|
| Rate for Payer: Cash Price |
$518.05
|
| Rate for Payer: Cash Price |
$518.05
|
| Rate for Payer: Devoted Health Medicare |
$438.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$398.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$757.15
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Humana Medicare |
$398.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$717.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$406.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$398.50
|
| Rate for Payer: MDX Hawaii PPO |
$773.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$398.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$398.50
|
| Rate for Payer: University Health Alliance Commercial |
$580.93
|
|
|
P9016 PACKED CELLS [HHSC]
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
13369156
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: AlohaCare Medicaid |
$398.50
|
| Rate for Payer: AlohaCare Medicare |
$398.50
|
| Rate for Payer: Cash Price |
$518.05
|
| Rate for Payer: Cash Price |
$518.05
|
| Rate for Payer: Devoted Health Medicare |
$438.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$398.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$757.15
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Humana Medicare |
$398.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$717.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$406.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$398.50
|
| Rate for Payer: MDX Hawaii PPO |
$773.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$398.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$398.50
|
| Rate for Payer: University Health Alliance Commercial |
$580.93
|
|
|
P9016 PACKED CELLS [HHSC]
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
13369156
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$677.45 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: Cash Price |
$518.05
|
| Rate for Payer: Health Management Network Commercial |
$677.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$717.30
|
| Rate for Payer: MDX Hawaii PPO |
$773.09
|
|
|
P9017 FFP Ea Unit
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
8258888
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$172.00
|
| Rate for Payer: AlohaCare Medicare |
$172.00
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Devoted Health Medicare |
$189.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$326.80
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$172.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.00
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.00
|
| Rate for Payer: University Health Alliance Commercial |
$250.74
|
|
|
P9017 FFP Ea Unit
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
8258888
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
P9017 FFP Ea Unit [HHSC]
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
13359442
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
P9017 FFP Ea Unit [HHSC]
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
13359442
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$172.00
|
| Rate for Payer: AlohaCare Medicare |
$172.00
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Devoted Health Medicare |
$189.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$326.80
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$172.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$309.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.00
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.00
|
| Rate for Payer: University Health Alliance Commercial |
$250.74
|
|
|
P9019 Platelet Ea Unit
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
8258889
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.80
|
| Rate for Payer: MDX Hawaii PPO |
$244.44
|
|
|
P9019 Platelet Ea Unit
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
8258889
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: AlohaCare Medicaid |
$126.00
|
| Rate for Payer: AlohaCare Medicare |
$126.00
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Devoted Health Medicare |
$138.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$239.40
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$244.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.00
|
| Rate for Payer: University Health Alliance Commercial |
$183.68
|
|
|
P9019 Platelet Ea Unit [HHSC]
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
13357628
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: AlohaCare Medicaid |
$126.00
|
| Rate for Payer: AlohaCare Medicare |
$126.00
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Devoted Health Medicare |
$138.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$239.40
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$128.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$244.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.00
|
| Rate for Payer: University Health Alliance Commercial |
$183.68
|
|
|
P9019 Platelet Ea Unit [HHSC]
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
13357628
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$244.44 |
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Health Management Network Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.80
|
| Rate for Payer: MDX Hawaii PPO |
$244.44
|
|
|
P9021 RBC Ea Unit
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
8258890
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: AlohaCare Medicaid |
$296.00
|
| Rate for Payer: AlohaCare Medicare |
$296.00
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Devoted Health Medicare |
$325.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$188.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$562.40
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Humana Medicare |
$296.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$296.00
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.00
|
| Rate for Payer: University Health Alliance Commercial |
$431.51
|
|
|
P9021 RBC Ea Unit
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
8258890
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
|
|
P9021 RBC Ea Unit [HHSC]
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
13369165
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
|
|
P9021 RBC Ea Unit [HHSC]
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
13369165
|
|
Hospital Revenue Code
|
380
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: AlohaCare Medicaid |
$296.00
|
| Rate for Payer: AlohaCare Medicare |
$296.00
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Devoted Health Medicare |
$325.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$188.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$562.40
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Humana Medicare |
$296.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$296.00
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.00
|
| Rate for Payer: University Health Alliance Commercial |
$431.51
|
|
|
P9031 Platelets Leuko Reduc Ea
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
8258891
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: AlohaCare Medicaid |
$234.50
|
| Rate for Payer: AlohaCare Medicare |
$234.50
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Devoted Health Medicare |
$257.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$180.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.55
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Humana Medicare |
$234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.50
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.50
|
| Rate for Payer: University Health Alliance Commercial |
$341.85
|
|
|
P9031 Platelets Leuko Reduc Ea
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
8258891
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$454.93 |
| Rate for Payer: Cash Price |
$304.85
|
| Rate for Payer: Health Management Network Commercial |
$398.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: MDX Hawaii PPO |
$454.93
|
|
