|
benztropine 1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
2500107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: AlohaCare Medicaid |
$1.64
|
| Rate for Payer: AlohaCare Medicare |
$1.64
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Devoted Health Medicare |
$1.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.11
|
| Rate for Payer: Health Management Network Commercial |
$2.78
|
| Rate for Payer: Humana Medicare |
$1.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.64
|
| Rate for Payer: MDX Hawaii PPO |
$3.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.64
|
| Rate for Payer: University Health Alliance Commercial |
$2.38
|
|
|
benztropine 1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 68084038801
|
| Hospital Charge Code |
2500107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Health Management Network Commercial |
$2.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.94
|
| Rate for Payer: MDX Hawaii PPO |
$3.17
|
|
|
benztropine 1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.27
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
2500107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: AlohaCare Medicaid |
$1.64
|
| Rate for Payer: AlohaCare Medicare |
$1.64
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Devoted Health Medicare |
$1.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.11
|
| Rate for Payer: Health Management Network Commercial |
$2.78
|
| Rate for Payer: Humana Medicare |
$1.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.64
|
| Rate for Payer: MDX Hawaii PPO |
$3.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.64
|
| Rate for Payer: University Health Alliance Commercial |
$2.38
|
|
|
benztropine 1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.27
|
|
|
Service Code
|
NDC 60687036801
|
| Hospital Charge Code |
2500107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Health Management Network Commercial |
$2.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.94
|
| Rate for Payer: MDX Hawaii PPO |
$3.17
|
|
|
benztropine 2mg/2mL ampule [HHSC]
|
Facility
|
IP
|
$361.43
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
2500108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$307.22 |
| Max. Negotiated Rate |
$350.59 |
| Rate for Payer: Kaiser Permanente Commercial |
$325.29
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Cash Price |
$214.57
|
| Rate for Payer: Cash Price |
$200.08
|
| Rate for Payer: Health Management Network Commercial |
$261.64
|
| Rate for Payer: Health Management Network Commercial |
$307.22
|
| Rate for Payer: Health Management Network Commercial |
$280.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.03
|
| Rate for Payer: MDX Hawaii PPO |
$320.21
|
| Rate for Payer: MDX Hawaii PPO |
$298.58
|
| Rate for Payer: MDX Hawaii PPO |
$350.59
|
|
|
benztropine 2mg/2mL ampule [HHSC]
|
Facility
|
OP
|
$307.81
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
2500108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$298.58 |
| Rate for Payer: AlohaCare Medicaid |
$153.91
|
| Rate for Payer: AlohaCare Medicaid |
$180.72
|
| Rate for Payer: AlohaCare Medicaid |
$165.06
|
| Rate for Payer: AlohaCare Medicare |
$165.06
|
| Rate for Payer: AlohaCare Medicare |
$153.91
|
| Rate for Payer: AlohaCare Medicare |
$180.72
|
| Rate for Payer: Cash Price |
$214.57
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Cash Price |
$214.57
|
| Rate for Payer: Cash Price |
$200.08
|
| Rate for Payer: Cash Price |
$200.08
|
| Rate for Payer: Cash Price |
$234.93
|
| Rate for Payer: Devoted Health Medicare |
$169.30
|
| Rate for Payer: Devoted Health Medicare |
$198.79
|
| Rate for Payer: Devoted Health Medicare |
$181.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$292.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$343.36
|
| Rate for Payer: Health Management Network Commercial |
$307.22
|
| Rate for Payer: Health Management Network Commercial |
$261.64
|
| Rate for Payer: Health Management Network Commercial |
$280.59
|
| Rate for Payer: Humana Medicare |
$153.91
|
| Rate for Payer: Humana Medicare |
$165.06
|
| Rate for Payer: Humana Medicare |
$180.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$325.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$168.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.72
|
| Rate for Payer: MDX Hawaii PPO |
$350.59
|
| Rate for Payer: MDX Hawaii PPO |
$320.21
|
| Rate for Payer: MDX Hawaii PPO |
$298.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$198.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.72
|
| Rate for Payer: University Health Alliance Commercial |
$224.36
|
| Rate for Payer: University Health Alliance Commercial |
$240.62
|
| Rate for Payer: University Health Alliance Commercial |
$263.45
|
|
|
benztropine 2 mg tablet [HHSC]
|
Facility
|
IP
|
$3.73
|
|
|
Service Code
|
NDC 60687037901
|
| Hospital Charge Code |
2500109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Health Management Network Commercial |
$3.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.36
|
| Rate for Payer: MDX Hawaii PPO |
$3.62
|
|
|
benztropine 2 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00603243921
|
| Hospital Charge Code |
2500109
|
|
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
|
|
|
benztropine 2 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00603243921
|
| Hospital Charge Code |
2500109
|
|
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
|
|
|
benztropine 2 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00603243521
|
| Hospital Charge Code |
2500109
|
|
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
|
|
|
benztropine 2 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00603243521
|
| Hospital Charge Code |
2500109
|
|
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
|
|
|
benztropine 2 mg tablet [HHSC]
|
Facility
|
OP
|
$3.73
|
|
|
Service Code
|
NDC 60687037901
|
| Hospital Charge Code |
2500109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: AlohaCare Medicaid |
$1.86
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Devoted Health Medicare |
$2.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network Commercial |
$3.17
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: MDX Hawaii PPO |
$3.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: University Health Alliance Commercial |
$2.72
|
|
|
Beta HCG Quantitative FSI
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
8117856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.80
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
|
|
Beta HCG Quantitative FSI
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
8117856
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: AlohaCare Medicaid |
$286.00
|
| Rate for Payer: AlohaCare Medicare |
$286.00
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Devoted Health Medicare |
$314.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: Humana Medicare |
$286.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.00
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.00
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
Beta-Hydroxybutyrate FSI
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
8228842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
Beta-Hydroxybutyrate FSI
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
8228842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$60.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$66.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$60.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.00
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
|
IP
|
$66,318.20
|
|
|
Service Code
|
MSDRG 461
|
| Min. Negotiated Rate |
$66,318.20 |
| Max. Negotiated Rate |
$66,318.20 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66,318.20
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
|
IP
|
$66,318.20
|
|
|
Service Code
|
MSDRG 462
|
| Min. Negotiated Rate |
$66,318.20 |
| Max. Negotiated Rate |
$66,318.20 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66,318.20
|
|
|
Bile Acids, Fract and Total, Preg.
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
12499891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$344.35 |
| Rate for Payer: AlohaCare Medicaid |
$177.50
|
| Rate for Payer: AlohaCare Medicare |
$177.50
|
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Devoted Health Medicare |
$195.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.09
|
| Rate for Payer: Health Management Network Commercial |
$301.75
|
| Rate for Payer: Humana Medicare |
$177.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$181.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.50
|
| Rate for Payer: MDX Hawaii PPO |
$344.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.50
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
Bile Acids, Fract and Total, Preg.
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
12499891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$301.75 |
| Max. Negotiated Rate |
$344.35 |
| Rate for Payer: Cash Price |
$230.75
|
| Rate for Payer: Health Management Network Commercial |
$301.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$319.50
|
| Rate for Payer: MDX Hawaii PPO |
$344.35
|
|
|
Bile Acids, Total FSI
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
8117857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: AlohaCare Medicaid |
$97.50
|
| Rate for Payer: AlohaCare Medicare |
$97.50
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Devoted Health Medicare |
$107.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.12
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Humana Medicare |
$97.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.50
|
| Rate for Payer: MDX Hawaii PPO |
$189.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.50
|
| Rate for Payer: University Health Alliance Commercial |
$44.29
|
|
|
Bile Acids, Total FSI
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 82239
|
| Hospital Charge Code |
8117857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Cash Price |
$126.75
|
| Rate for Payer: Health Management Network Commercial |
$165.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$189.15
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$46,242.60
|
|
|
Service Code
|
MSDRG 409
|
| Min. Negotiated Rate |
$46,242.60 |
| Max. Negotiated Rate |
$46,242.60 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46,242.60
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$46,242.60
|
|
|
Service Code
|
MSDRG 408
|
| Min. Negotiated Rate |
$46,242.60 |
| Max. Negotiated Rate |
$46,242.60 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46,242.60
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$45,247.12
|
|
|
Service Code
|
MSDRG 410
|
| Min. Negotiated Rate |
$45,247.12 |
| Max. Negotiated Rate |
$45,247.12 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45,247.12
|
|
