|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$17,821.70
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$17,821.70 |
| Max. Negotiated Rate |
$17,821.70 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,821.70
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$17,821.70
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$17,821.70 |
| Max. Negotiated Rate |
$17,821.70 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,821.70
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,821.70
|
|
|
Service Code
|
MSDRG 561
|
| Min. Negotiated Rate |
$17,821.70 |
| Max. Negotiated Rate |
$17,821.70 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,821.70
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
|
IP
|
$18,943.53
|
|
|
Service Code
|
MSDRG 949
|
| Min. Negotiated Rate |
$18,943.53 |
| Max. Negotiated Rate |
$18,943.53 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,943.53
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
|
IP
|
$5,609.12
|
|
|
Service Code
|
MSDRG 950
|
| Min. Negotiated Rate |
$5,609.12 |
| Max. Negotiated Rate |
$5,609.12 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,609.12
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$83,167.95
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$83,167.95 |
| Max. Negotiated Rate |
$83,167.95 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83,167.95
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$83,167.95
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$83,167.95 |
| Max. Negotiated Rate |
$83,167.95 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83,167.95
|
|
|
AIRWAY LARYNGEAL MASK LMA GASTRO ADULT SIZE 4 CUFFED BLUE/WHITE
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
9884519
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
AIRWAY LARYNGEAL MASK LMA GASTRO ADULT SIZE 4 CUFFED BLUE/WHITE
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
9884519
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$87.50
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$96.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.25
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$87.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.50
|
| Rate for Payer: University Health Alliance Commercial |
$127.56
|
|
|
AIRWAY LARYNGEAL MASK LMA GASTRO ADULT SIZE 5 CUFFED BLUE/WHITE
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
9884520
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$87.50
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$96.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.25
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$87.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.50
|
| Rate for Payer: University Health Alliance Commercial |
$127.56
|
|
|
AIRWAY LARYNGEAL MASK LMA GASTRO ADULT SIZE 5 CUFFED BLUE/WHITE
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
9884520
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
Albumin, Body Fluid FSI
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
8228833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$36.50
|
| Rate for Payer: Cash Price |
$47.45
|
| Rate for Payer: Cash Price |
$47.45
|
| Rate for Payer: Devoted Health Medicare |
$40.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$36.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.50
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
Albumin, Body Fluid FSI
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 82042
|
| Hospital Charge Code |
8228833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$47.45
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
|
Albumin/Creatinine Ratio, Urine FSI
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
8117769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
Albumin/Creatinine Ratio, Urine FSI
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
8117769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$49.00
|
| Rate for Payer: AlohaCare Medicare |
$49.00
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$53.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.78
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$49.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.00
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.00
|
| Rate for Payer: University Health Alliance Commercial |
$14.97
|
|
|
Albumin FSI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
8117768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.50
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.80
|
|
|
Albumin FSI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
8117768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
albumin human 25% 100mL [HHSC]
|
Facility
|
OP
|
$618.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
2500873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$599.65 |
| Rate for Payer: Kaiser Permanente Commercial |
$624.10
|
| Rate for Payer: AlohaCare Medicaid |
$309.10
|
| Rate for Payer: AlohaCare Medicaid |
$346.72
|
| Rate for Payer: AlohaCare Medicaid |
$241.38
|
| Rate for Payer: AlohaCare Medicare |
$346.72
|
| Rate for Payer: AlohaCare Medicare |
$309.10
|
| Rate for Payer: AlohaCare Medicare |
$241.38
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$401.83
|
| Rate for Payer: Cash Price |
$401.83
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Devoted Health Medicare |
$381.39
|
| Rate for Payer: Devoted Health Medicare |
$265.52
|
| Rate for Payer: Devoted Health Medicare |
$340.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$346.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$309.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$458.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$658.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$587.29
|
| Rate for Payer: Health Management Network Commercial |
$410.35
|
| Rate for Payer: Health Management Network Commercial |
$589.42
|
| Rate for Payer: Health Management Network Commercial |
$525.47
|
| Rate for Payer: Humana Medicare |
$346.72
|
| Rate for Payer: Humana Medicare |
$309.10
|
| Rate for Payer: Humana Medicare |
$241.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$556.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$315.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$353.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$241.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$309.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$346.72
|
| Rate for Payer: MDX Hawaii PPO |
$672.64
|
| Rate for Payer: MDX Hawaii PPO |
$468.29
|
| Rate for Payer: MDX Hawaii PPO |
$599.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$241.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$346.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$346.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$309.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$309.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$346.72
|
| Rate for Payer: University Health Alliance Commercial |
$450.61
|
| Rate for Payer: University Health Alliance Commercial |
$505.45
|
| Rate for Payer: University Health Alliance Commercial |
$351.89
|
|
|
albumin human 25% 100mL [HHSC]
|
Facility
|
IP
|
$693.44
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
2500873
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$589.42 |
| Max. Negotiated Rate |
$672.64 |
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$401.83
|
| Rate for Payer: Health Management Network Commercial |
$589.42
|
| Rate for Payer: Health Management Network Commercial |
$525.47
|
| Rate for Payer: Health Management Network Commercial |
$410.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$556.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$624.10
|
| Rate for Payer: MDX Hawaii PPO |
$599.65
|
| Rate for Payer: MDX Hawaii PPO |
$468.29
|
| Rate for Payer: MDX Hawaii PPO |
$672.64
|
|
|
albumin human 25% 12.5 g/50 mL [HHSC]
|
Facility
|
IP
|
$404.09
|
|
|
Service Code
|
NDC 76125079225
|
| Hospital Charge Code |
2501159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$343.48 |
| Max. Negotiated Rate |
$391.97 |
| Rate for Payer: Cash Price |
$262.66
|
| Rate for Payer: Health Management Network Commercial |
$343.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.68
|
| Rate for Payer: MDX Hawaii PPO |
$391.97
|
|
|
albumin human 25% 12.5 g/50 mL [HHSC]
|
Facility
|
OP
|
$404.09
|
|
|
Service Code
|
NDC 76125079225
|
| Hospital Charge Code |
2501159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$202.04 |
| Max. Negotiated Rate |
$391.97 |
| Rate for Payer: AlohaCare Medicaid |
$202.04
|
| Rate for Payer: AlohaCare Medicare |
$202.04
|
| Rate for Payer: Cash Price |
$262.66
|
| Rate for Payer: Devoted Health Medicare |
$222.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$202.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$383.89
|
| Rate for Payer: Health Management Network Commercial |
$343.48
|
| Rate for Payer: Humana Medicare |
$202.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.04
|
| Rate for Payer: MDX Hawaii PPO |
$391.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$242.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.04
|
| Rate for Payer: University Health Alliance Commercial |
$294.54
|
|
|
albumin human 5% 250 mL [HHSC]
|
Facility
|
OP
|
$300.88
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
2500029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: AlohaCare Medicaid |
$150.44
|
| Rate for Payer: AlohaCare Medicaid |
$233.86
|
| Rate for Payer: AlohaCare Medicaid |
$147.43
|
| Rate for Payer: AlohaCare Medicare |
$150.44
|
| Rate for Payer: AlohaCare Medicare |
$233.86
|
| Rate for Payer: AlohaCare Medicare |
$147.43
|
| Rate for Payer: Cash Price |
$195.57
|
| Rate for Payer: Cash Price |
$191.66
|
| Rate for Payer: Cash Price |
$191.66
|
| Rate for Payer: Cash Price |
$195.57
|
| Rate for Payer: Cash Price |
$304.02
|
| Rate for Payer: Cash Price |
$304.02
|
| Rate for Payer: Devoted Health Medicare |
$162.17
|
| Rate for Payer: Devoted Health Medicare |
$165.48
|
| Rate for Payer: Devoted Health Medicare |
$257.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$233.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$444.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$280.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$285.84
|
| Rate for Payer: Health Management Network Commercial |
$255.75
|
| Rate for Payer: Health Management Network Commercial |
$250.63
|
| Rate for Payer: Health Management Network Commercial |
$397.56
|
| Rate for Payer: Humana Medicare |
$147.43
|
| Rate for Payer: Humana Medicare |
$150.44
|
| Rate for Payer: Humana Medicare |
$233.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$420.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.86
|
| Rate for Payer: MDX Hawaii PPO |
$291.85
|
| Rate for Payer: MDX Hawaii PPO |
$453.69
|
| Rate for Payer: MDX Hawaii PPO |
$286.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$233.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$280.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$180.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$233.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.43
|
| Rate for Payer: University Health Alliance Commercial |
$340.92
|
| Rate for Payer: University Health Alliance Commercial |
$214.92
|
| Rate for Payer: University Health Alliance Commercial |
$219.31
|
|
|
albumin human 5% 250 mL [HHSC]
|
Facility
|
IP
|
$300.88
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
2500029
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$255.75 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Cash Price |
$195.57
|
| Rate for Payer: Cash Price |
$191.66
|
| Rate for Payer: Cash Price |
$304.02
|
| Rate for Payer: Health Management Network Commercial |
$397.56
|
| Rate for Payer: Health Management Network Commercial |
$250.63
|
| Rate for Payer: Health Management Network Commercial |
$255.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$420.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.79
|
| Rate for Payer: MDX Hawaii PPO |
$291.85
|
| Rate for Payer: MDX Hawaii PPO |
$286.01
|
| Rate for Payer: MDX Hawaii PPO |
$453.69
|
|
|
albuterol 2.5mg/3ml neb soln [HHSC]
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2500030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Health Management Network Commercial |
$3.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.00
|
| Rate for Payer: MDX Hawaii PPO |
$4.32
|
|
|
albuterol 2.5mg/3ml neb soln [HHSC]
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2500030
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: AlohaCare Medicaid |
$2.23
|
| Rate for Payer: AlohaCare Medicare |
$2.23
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Devoted Health Medicare |
$2.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.23
|
| Rate for Payer: Health Management Network Commercial |
$3.78
|
| Rate for Payer: Humana Medicare |
$2.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.23
|
| Rate for Payer: MDX Hawaii PPO |
$4.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.23
|
| Rate for Payer: University Health Alliance Commercial |
$3.24
|
|
