|
99418 PROLONGED INPT/OBSV E&M W/WO DIRECT PAT CONTACT, 15 MIN OF TOTAL TIME
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99418
|
| Hospital Charge Code |
10602925
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
|
|
99460 Initial Hospital Care, Per Day, Normal Newborn
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
8041132
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$270.30 |
| Rate for Payer: AlohaCare Medicaid |
$93.11
|
| Rate for Payer: AlohaCare Medicare |
$80.88
|
| Rate for Payer: Cash Price |
$206.70
|
| Rate for Payer: Cash Price |
$206.70
|
| Rate for Payer: Devoted Health Medicare |
$88.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.34
|
| Rate for Payer: Health Management Network Commercial |
$270.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.88
|
|
|
99462 Subsequent Hospital Care Normal Newborn
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
8041134
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: AlohaCare Medicaid |
$40.94
|
| Rate for Payer: AlohaCare Medicare |
$35.48
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Devoted Health Medicare |
$39.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.81
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.48
|
|
|
99463 Initial Hospital Care Normal Newborn, Same Day Admit/Dc
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 99463
|
| Hospital Charge Code |
8041135
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: AlohaCare Medicaid |
$109.27
|
| Rate for Payer: AlohaCare Medicare |
$95.68
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Cash Price |
$250.25
|
| Rate for Payer: Devoted Health Medicare |
$105.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.81
|
| Rate for Payer: Health Management Network Commercial |
$327.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$109.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.68
|
|
|
99464 Attendance at Delivery & Initial Stabilization of Newborn
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
8041136
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$63.42 |
| Max. Negotiated Rate |
$223.55 |
| Rate for Payer: AlohaCare Medicaid |
$72.83
|
| Rate for Payer: AlohaCare Medicare |
$63.42
|
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Devoted Health Medicare |
$69.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.31
|
| Rate for Payer: Health Management Network Commercial |
$223.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.42
|
|
|
99477 Initial ICU Care Neonate; < 28 Days
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 99477
|
| Hospital Charge Code |
8041142
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$295.67 |
| Max. Negotiated Rate |
$820.25 |
| Rate for Payer: AlohaCare Medicaid |
$339.70
|
| Rate for Payer: AlohaCare Medicare |
$295.67
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Devoted Health Medicare |
$325.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.05
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$325.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$325.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.67
|
|
|
ABO Group FSI
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
8117758
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
ABO Group FSI
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
8117758
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$47.00
|
| Rate for Payer: AlohaCare Medicare |
$47.00
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Devoted Health Medicare |
$51.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$47.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.00
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.00
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
ABO RH Antibody Screen (Not XM Convertible) FSI
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
8117759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$80.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$88.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.77
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$80.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.88
|
|
|
ABO RH Antibody Screen (Not XM Convertible) FSI
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
8117759
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$11,575.18
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$11,575.18 |
| Max. Negotiated Rate |
$11,575.18 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11,575.18
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$7,903.76
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$7,903.76 |
| Max. Negotiated Rate |
$7,903.76 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,903.76
|
|
|
Abscess Culture with Gram stain
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
12516235
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
|
|
Abscess Culture with Gram stain
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
12516235
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: AlohaCare Medicaid |
$53.50
|
| Rate for Payer: AlohaCare Medicare |
$53.50
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Devoted Health Medicare |
$58.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Humana Medicare |
$53.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.50
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
Abscess Culture with Gram stain bill only
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
12539009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
|
|
Abscess Culture with Gram stain bill only
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
12539009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: AlohaCare Medicaid |
$53.50
|
| Rate for Payer: AlohaCare Medicare |
$53.50
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Devoted Health Medicare |
$58.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Humana Medicare |
$53.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.50
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
Abscess Culture with Gram stain - Bill only
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
12514773
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
|
|
Abscess Culture with Gram stain - Bill only
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
12514773
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: AlohaCare Medicaid |
$53.50
|
| Rate for Payer: AlohaCare Medicare |
$53.50
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Devoted Health Medicare |
$58.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Humana Medicare |
$53.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.50
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
ABSORBATACK FIXATION DEVICE
|
Facility
|
IP
|
$2,456.00
|
|
| Hospital Charge Code |
10109437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,087.60 |
| Max. Negotiated Rate |
$2,382.32 |
| Rate for Payer: Cash Price |
$1,596.40
|
| Rate for Payer: Health Management Network Commercial |
$2,087.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,210.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,382.32
|
|
|
ABSORBATACK FIXATION DEVICE
|
Facility
|
OP
|
$2,456.00
|
|
| Hospital Charge Code |
10109437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,228.00 |
| Max. Negotiated Rate |
$2,382.32 |
| Rate for Payer: AlohaCare Medicaid |
$1,228.00
|
| Rate for Payer: AlohaCare Medicare |
$1,228.00
|
| Rate for Payer: Cash Price |
$1,596.40
|
| Rate for Payer: Devoted Health Medicare |
$1,350.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,228.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,333.20
|
| Rate for Payer: Health Management Network Commercial |
$2,087.60
|
| Rate for Payer: Humana Medicare |
$1,228.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,210.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,252.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,228.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,382.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,228.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,228.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,228.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,790.18
|
|
|
acetaminophen 1000 mg/100 mL injection [HHSC]
|
Facility
|
IP
|
$72.57
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
2501174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.68 |
| Max. Negotiated Rate |
$70.39 |
| Rate for Payer: Cash Price |
$47.17
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Health Management Network Commercial |
$173.21
|
| Rate for Payer: Health Management Network Commercial |
$61.68
|
| Rate for Payer: Health Management Network Commercial |
$49.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.40
|
| Rate for Payer: MDX Hawaii PPO |
$56.15
|
| Rate for Payer: MDX Hawaii PPO |
$197.67
|
| Rate for Payer: MDX Hawaii PPO |
$70.39
|
|
|
acetaminophen 1000 mg/100 mL injection [HHSC]
|
Facility
|
OP
|
$203.78
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
2501174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$197.67 |
| Rate for Payer: AlohaCare Medicaid |
$101.89
|
| Rate for Payer: AlohaCare Medicaid |
$36.28
|
| Rate for Payer: AlohaCare Medicaid |
$28.95
|
| Rate for Payer: AlohaCare Medicare |
$28.95
|
| Rate for Payer: AlohaCare Medicare |
$101.89
|
| Rate for Payer: AlohaCare Medicare |
$36.28
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Cash Price |
$47.17
|
| Rate for Payer: Cash Price |
$37.63
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$47.17
|
| Rate for Payer: Devoted Health Medicare |
$112.08
|
| Rate for Payer: Devoted Health Medicare |
$39.91
|
| Rate for Payer: Devoted Health Medicare |
$31.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$193.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.94
|
| Rate for Payer: Health Management Network Commercial |
$61.68
|
| Rate for Payer: Health Management Network Commercial |
$173.21
|
| Rate for Payer: Health Management Network Commercial |
$49.21
|
| Rate for Payer: Humana Medicare |
$101.89
|
| Rate for Payer: Humana Medicare |
$28.95
|
| Rate for Payer: Humana Medicare |
$36.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.28
|
| Rate for Payer: MDX Hawaii PPO |
$70.39
|
| Rate for Payer: MDX Hawaii PPO |
$56.15
|
| Rate for Payer: MDX Hawaii PPO |
$197.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.28
|
| Rate for Payer: University Health Alliance Commercial |
$148.54
|
| Rate for Payer: University Health Alliance Commercial |
$42.20
|
| Rate for Payer: University Health Alliance Commercial |
$52.90
|
|
|
acetaminophen 120 mg suppository [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 45802073233
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
acetaminophen 120 mg suppository [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 45802073233
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
acetaminophen 120 mg suppository [HHSC]
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
2500001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Health Management Network Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.01
|
| Rate for Payer: MDX Hawaii PPO |
$4.33
|
|
