|
U Urealyticum Amp Probe
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
10023501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: AlohaCare Medicaid |
$182.50
|
| Rate for Payer: AlohaCare Medicare |
$182.50
|
| Rate for Payer: Cash Price |
$237.25
|
| Rate for Payer: Cash Price |
$237.25
|
| Rate for Payer: Devoted Health Medicare |
$200.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$310.25
|
| Rate for Payer: Humana Medicare |
$182.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$328.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.50
|
| Rate for Payer: MDX Hawaii PPO |
$354.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.50
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
Vag Delivery Recov Lvl 1 Charge
|
Facility
|
OP
|
$3,194.00
|
|
| Hospital Charge Code |
8140424
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$1,597.00 |
| Max. Negotiated Rate |
$3,098.18 |
| Rate for Payer: AlohaCare Medicaid |
$1,597.00
|
| Rate for Payer: AlohaCare Medicare |
$1,597.00
|
| Rate for Payer: Cash Price |
$2,076.10
|
| Rate for Payer: Devoted Health Medicare |
$1,756.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,597.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,034.30
|
| Rate for Payer: Health Management Network Commercial |
$2,714.90
|
| Rate for Payer: Humana Medicare |
$1,597.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,874.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,628.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,597.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,098.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,597.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,597.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,597.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,328.11
|
|
|
Vag Delivery Recov Lvl 1 Charge
|
Facility
|
IP
|
$3,194.00
|
|
| Hospital Charge Code |
8140424
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$2,714.90 |
| Max. Negotiated Rate |
$3,098.18 |
| Rate for Payer: Cash Price |
$2,076.10
|
| Rate for Payer: Health Management Network Commercial |
$2,714.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,874.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,098.18
|
|
|
Vag Delivery Recov Lvl 2 Charge
|
Facility
|
OP
|
$3,833.00
|
|
| Hospital Charge Code |
8140427
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$1,916.50 |
| Max. Negotiated Rate |
$3,718.01 |
| Rate for Payer: AlohaCare Medicaid |
$1,916.50
|
| Rate for Payer: AlohaCare Medicare |
$1,916.50
|
| Rate for Payer: Cash Price |
$2,491.45
|
| Rate for Payer: Devoted Health Medicare |
$2,108.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,916.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,641.35
|
| Rate for Payer: Health Management Network Commercial |
$3,258.05
|
| Rate for Payer: Humana Medicare |
$1,916.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,449.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,954.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,916.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,718.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,916.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,916.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,916.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,793.87
|
|
|
Vag Delivery Recov Lvl 2 Charge
|
Facility
|
IP
|
$3,833.00
|
|
| Hospital Charge Code |
8140427
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$3,258.05 |
| Max. Negotiated Rate |
$3,718.01 |
| Rate for Payer: Cash Price |
$2,491.45
|
| Rate for Payer: Health Management Network Commercial |
$3,258.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,449.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,718.01
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$28,453.54
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$28,453.54 |
| Max. Negotiated Rate |
$28,453.54 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28,453.54
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,453.54
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$28,453.54 |
| Max. Negotiated Rate |
$28,453.54 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28,453.54
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$13,436.39
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$13,436.39 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,436.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$10,886.79
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$10,886.79 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,886.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$10,886.79
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$10,886.79 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,886.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$9,815.96
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$9,815.96 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,815.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$15,807.52
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$15,807.52 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,807.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$15,807.52
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$15,807.52 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,807.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$15,807.52
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$7,300.00 |
| Max. Negotiated Rate |
$15,807.52 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,807.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,300.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,760.00
|
|
|
Vaginitis Panel NAAT FSI
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
11185799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$362.78 |
| Rate for Payer: AlohaCare Medicaid |
$187.00
|
| Rate for Payer: AlohaCare Medicare |
$187.00
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Devoted Health Medicare |
$205.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Humana Medicare |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$190.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.00
|
| Rate for Payer: MDX Hawaii PPO |
$362.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.00
|
| Rate for Payer: University Health Alliance Commercial |
$88.56
|
|
|
Vaginitis Panel NAAT FSI
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
11185799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$317.90 |
| Max. Negotiated Rate |
$362.78 |
| Rate for Payer: Cash Price |
$243.10
|
| Rate for Payer: Health Management Network Commercial |
$317.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$336.60
|
| Rate for Payer: MDX Hawaii PPO |
$362.78
|
|
|
Vaginitis Rapid DNA FSI
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
8118076
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: AlohaCare Medicaid |
$115.00
|
| Rate for Payer: AlohaCare Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$126.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Humana Medicare |
$115.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.00
|
| Rate for Payer: University Health Alliance Commercial |
$51.84
|
|
|
Vaginitis Rapid DNA FSI
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87480
|
| Hospital Charge Code |
8118076
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
|
valACYclovir 1000 mg tablet [HHSC]
|
Facility
|
OP
|
$70.99
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501051
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Humana Medicare |
$35.49
|
| Rate for Payer: AlohaCare Medicaid |
$35.49
|
| Rate for Payer: AlohaCare Medicaid |
$19.93
|
| Rate for Payer: AlohaCare Medicaid |
$21.80
|
| Rate for Payer: AlohaCare Medicare |
$19.93
|
| Rate for Payer: AlohaCare Medicare |
$35.49
|
| Rate for Payer: AlohaCare Medicare |
$21.80
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$46.14
|
| Rate for Payer: Devoted Health Medicare |
$23.99
|
| Rate for Payer: Devoted Health Medicare |
$21.92
|
| Rate for Payer: Devoted Health Medicare |
$39.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.86
|
| Rate for Payer: Health Management Network Commercial |
$33.87
|
| Rate for Payer: Health Management Network Commercial |
$60.34
|
| Rate for Payer: Health Management Network Commercial |
$37.07
|
| Rate for Payer: Humana Medicare |
$19.93
|
| Rate for Payer: Humana Medicare |
$21.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.80
|
| Rate for Payer: MDX Hawaii PPO |
$68.86
|
| Rate for Payer: MDX Hawaii PPO |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$38.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.93
|
| Rate for Payer: University Health Alliance Commercial |
$51.74
|
| Rate for Payer: University Health Alliance Commercial |
$29.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.79
|
|
|
valACYclovir 1000 mg tablet [HHSC]
|
Facility
|
IP
|
$70.99
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.34 |
| Max. Negotiated Rate |
$68.86 |
| Rate for Payer: Cash Price |
$46.14
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Health Management Network Commercial |
$60.34
|
| Rate for Payer: Health Management Network Commercial |
$33.87
|
| Rate for Payer: Health Management Network Commercial |
$37.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.89
|
| Rate for Payer: MDX Hawaii PPO |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$38.65
|
| Rate for Payer: MDX Hawaii PPO |
$68.86
|
|
|
valACYclovir 500 mg tablet [HHSC]
|
Facility
|
OP
|
$44.86
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$43.51 |
| Rate for Payer: AlohaCare Medicaid |
$22.43
|
| Rate for Payer: AlohaCare Medicaid |
$16.59
|
| Rate for Payer: AlohaCare Medicaid |
$10.31
|
| Rate for Payer: AlohaCare Medicaid |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$10.31
|
| Rate for Payer: AlohaCare Medicare |
$22.43
|
| Rate for Payer: AlohaCare Medicare |
$16.59
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$29.16
|
| Rate for Payer: Devoted Health Medicare |
$12.15
|
| Rate for Payer: Devoted Health Medicare |
$24.67
|
| Rate for Payer: Devoted Health Medicare |
$11.34
|
| Rate for Payer: Devoted Health Medicare |
$18.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.62
|
| Rate for Payer: Health Management Network Commercial |
$18.78
|
| Rate for Payer: Health Management Network Commercial |
$17.53
|
| Rate for Payer: Health Management Network Commercial |
$28.21
|
| Rate for Payer: Health Management Network Commercial |
$38.13
|
| Rate for Payer: Humana Medicare |
$16.59
|
| Rate for Payer: Humana Medicare |
$11.04
|
| Rate for Payer: Humana Medicare |
$10.31
|
| Rate for Payer: Humana Medicare |
$22.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.43
|
| Rate for Payer: MDX Hawaii PPO |
$21.43
|
| Rate for Payer: MDX Hawaii PPO |
$32.19
|
| Rate for Payer: MDX Hawaii PPO |
$43.51
|
| Rate for Payer: MDX Hawaii PPO |
$20.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.31
|
| Rate for Payer: University Health Alliance Commercial |
$24.19
|
| Rate for Payer: University Health Alliance Commercial |
$16.10
|
| Rate for Payer: University Health Alliance Commercial |
$32.70
|
| Rate for Payer: University Health Alliance Commercial |
$15.03
|
|
|
valACYclovir 500 mg tablet [HHSC]
|
Facility
|
IP
|
$22.09
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$21.43 |
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cash Price |
$29.16
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Health Management Network Commercial |
$17.53
|
| Rate for Payer: Health Management Network Commercial |
$18.78
|
| Rate for Payer: Health Management Network Commercial |
$28.21
|
| Rate for Payer: Health Management Network Commercial |
$38.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.37
|
| Rate for Payer: MDX Hawaii PPO |
$21.43
|
| Rate for Payer: MDX Hawaii PPO |
$32.19
|
| Rate for Payer: MDX Hawaii PPO |
$43.51
|
| Rate for Payer: MDX Hawaii PPO |
$20.00
|
|
|
VAL KREULOCK SCREW, TI, 2.0 X 10MM
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13005604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$300.70 |
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.00
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
| Rate for Payer: University Health Alliance Commercial |
$173.60
|
|
|
VAL KREULOCK SCREW, TI, 2.0 X 10MM
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13005604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$300.70 |
| Rate for Payer: AlohaCare Medicaid |
$155.00
|
| Rate for Payer: AlohaCare Medicare |
$155.00
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Devoted Health Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.00
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Humana Medicare |
$155.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.00
|
| Rate for Payer: University Health Alliance Commercial |
$173.60
|
|
|
VAL KREULOCK SCREW, TI, 2.0 X 11MM
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
13002369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$300.70 |
| Rate for Payer: AlohaCare Medicaid |
$155.00
|
| Rate for Payer: AlohaCare Medicare |
$155.00
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Devoted Health Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$217.00
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Humana Medicare |
$155.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.00
|
| Rate for Payer: University Health Alliance Commercial |
$173.60
|
|
