|
Insertion of cervical dilator 59200
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
5544179
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$510.85 |
| Rate for Payer: AlohaCare Medicaid |
$42.45
|
| Rate for Payer: AlohaCare Medicare |
$55.92
|
| Rate for Payer: Cash Price |
$390.65
|
| Rate for Payer: Cash Price |
$390.65
|
| Rate for Payer: Devoted Health Medicare |
$61.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$65.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.02
|
| Rate for Payer: Health Management Network Commercial |
$510.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.92
|
| Rate for Payer: University Health Alliance Commercial |
$79.55
|
|
|
Insert Midcath > 3 years of age Charge
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
8386869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.65 |
| Max. Negotiated Rate |
$435.53 |
| Rate for Payer: Cash Price |
$291.85
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$404.10
|
| Rate for Payer: MDX Hawaii PPO |
$435.53
|
|
|
Insert Midcath > 3 years of age Charge
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
8386869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$224.50
|
| Rate for Payer: AlohaCare Medicare |
$224.50
|
| Rate for Payer: Cash Price |
$291.85
|
| Rate for Payer: Cash Price |
$291.85
|
| Rate for Payer: Devoted Health Medicare |
$246.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.55
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: Humana Medicare |
$224.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$404.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.50
|
| Rate for Payer: MDX Hawaii PPO |
$435.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$224.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.50
|
| Rate for Payer: University Health Alliance Commercial |
$327.28
|
|
|
Insert new site - Arterial Line Activity:
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8253453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: AlohaCare Medicaid |
$136.50
|
| Rate for Payer: AlohaCare Medicare |
$136.50
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Devoted Health Medicare |
$150.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.35
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Humana Medicare |
$136.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.50
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.50
|
| Rate for Payer: University Health Alliance Commercial |
$152.88
|
|
|
Insert new site - Arterial Line Activity:
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8253453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
Insert PICC Cath 5 yrs/> Charge w/out imaging Charge
|
Facility
|
OP
|
$4,007.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
8422798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,886.79 |
| Rate for Payer: AlohaCare Medicaid |
$2,003.50
|
| Rate for Payer: AlohaCare Medicare |
$2,003.50
|
| Rate for Payer: Cash Price |
$2,604.55
|
| Rate for Payer: Cash Price |
$2,604.55
|
| Rate for Payer: Devoted Health Medicare |
$2,203.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,003.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,806.65
|
| Rate for Payer: Health Management Network Commercial |
$3,405.95
|
| Rate for Payer: Humana Medicare |
$2,003.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,606.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,003.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,886.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,003.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,003.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,003.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,920.70
|
|
|
Insert PICC Cath 5 yrs/> Charge w/out imaging Charge
|
Facility
|
IP
|
$4,007.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
8422798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,405.95 |
| Max. Negotiated Rate |
$3,886.79 |
| Rate for Payer: Cash Price |
$2,604.55
|
| Rate for Payer: Health Management Network Commercial |
$3,405.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,606.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,886.79
|
|
|
Insulin, Fasting FSI
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
8117973
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
Insulin, Fasting FSI
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
8117973
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$66.50
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$73.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.43
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$66.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.50
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.50
|
| Rate for Payer: University Health Alliance Commercial |
$29.56
|
|
|
Insulin, Free w/ Total FSI
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 83527
|
| Hospital Charge Code |
8228886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$74.00
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$81.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.95
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.00
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
Insulin, Free w/ Total FSI
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 83527
|
| Hospital Charge Code |
8228886
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
insulin glargine 100 units/mL 3 mL pen [HHSC]
|
Facility
|
IP
|
$114.84
|
|
|
Service Code
|
NDC 00088221905
|
| Hospital Charge Code |
2501158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$111.39 |
| Rate for Payer: Cash Price |
$74.65
|
| Rate for Payer: Health Management Network Commercial |
$97.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.36
|
| Rate for Payer: MDX Hawaii PPO |
$111.39
|
|
|
insulin glargine 100 units/mL 3 mL pen [HHSC]
|
Facility
|
OP
|
$114.84
|
|
|
Service Code
|
NDC 00088221905
|
| Hospital Charge Code |
2501158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.42 |
| Max. Negotiated Rate |
$111.39 |
| Rate for Payer: AlohaCare Medicaid |
$57.42
|
| Rate for Payer: AlohaCare Medicare |
$57.42
|
| Rate for Payer: Cash Price |
$74.65
|
| Rate for Payer: Devoted Health Medicare |
$63.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.10
|
| Rate for Payer: Health Management Network Commercial |
$97.61
|
| Rate for Payer: Humana Medicare |
$57.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.42
|
| Rate for Payer: MDX Hawaii PPO |
$111.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.42
|
| Rate for Payer: University Health Alliance Commercial |
$83.71
|
|
|
insulin R 100 units/1 mL 10 mL vial [HHSC]
|
Facility
|
IP
|
$286.68
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$243.68 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Cash Price |
$186.34
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Health Management Network Commercial |
$243.68
|
| Rate for Payer: Health Management Network Commercial |
$256.45
|
| Rate for Payer: Health Management Network Commercial |
$243.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.54
|
| Rate for Payer: MDX Hawaii PPO |
$278.08
|
| Rate for Payer: MDX Hawaii PPO |
$278.11
|
| Rate for Payer: MDX Hawaii PPO |
$292.66
|
|
|
insulin R 100 units/1 mL 10 mL vial [HHSC]
|
Facility
|
OP
|
$286.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$278.11 |
| Rate for Payer: AlohaCare Medicaid |
$143.35
|
| Rate for Payer: AlohaCare Medicaid |
$150.85
|
| Rate for Payer: AlohaCare Medicaid |
$143.34
|
| Rate for Payer: AlohaCare Medicare |
$143.35
|
| Rate for Payer: AlohaCare Medicare |
$143.34
|
| Rate for Payer: AlohaCare Medicare |
$150.85
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Cash Price |
$186.34
|
| Rate for Payer: Cash Price |
$186.34
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Devoted Health Medicare |
$165.94
|
| Rate for Payer: Devoted Health Medicare |
$157.69
|
| Rate for Payer: Devoted Health Medicare |
$157.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.37
|
| Rate for Payer: Health Management Network Commercial |
$243.68
|
| Rate for Payer: Health Management Network Commercial |
$243.70
|
| Rate for Payer: Health Management Network Commercial |
$256.45
|
| Rate for Payer: Humana Medicare |
$143.35
|
| Rate for Payer: Humana Medicare |
$143.34
|
| Rate for Payer: Humana Medicare |
$150.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.85
|
| Rate for Payer: MDX Hawaii PPO |
$278.08
|
| Rate for Payer: MDX Hawaii PPO |
$292.66
|
| Rate for Payer: MDX Hawaii PPO |
$278.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.35
|
| Rate for Payer: University Health Alliance Commercial |
$219.92
|
| Rate for Payer: University Health Alliance Commercial |
$208.96
|
| Rate for Payer: University Health Alliance Commercial |
$208.98
|
|
|
insulin R 100 units/mL 3 mL pen [HHSC]
|
Facility
|
OP
|
$109.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501154
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: AlohaCare Medicaid |
$54.77
|
| Rate for Payer: AlohaCare Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Devoted Health Medicare |
$60.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.05
|
| Rate for Payer: Health Management Network Commercial |
$93.10
|
| Rate for Payer: Humana Medicare |
$54.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.77
|
| Rate for Payer: MDX Hawaii PPO |
$106.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.77
|
| Rate for Payer: University Health Alliance Commercial |
$79.84
|
|
|
insulin R 100 units/mL 3 mL pen [HHSC]
|
Facility
|
IP
|
$109.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Health Management Network Commercial |
$93.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.58
|
| Rate for Payer: MDX Hawaii PPO |
$106.24
|
|
|
INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
|
IP
|
$34,391.60
|
|
|
Service Code
|
MSDRG 197
|
| Min. Negotiated Rate |
$34,391.60 |
| Max. Negotiated Rate |
$34,391.60 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,391.60
|
|
|
INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
|
IP
|
$34,391.60
|
|
|
Service Code
|
MSDRG 196
|
| Min. Negotiated Rate |
$34,391.60 |
| Max. Negotiated Rate |
$34,391.60 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,391.60
|
|
|
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$34,391.60
|
|
|
Service Code
|
MSDRG 198
|
| Min. Negotiated Rate |
$34,391.60 |
| Max. Negotiated Rate |
$34,391.60 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,391.60
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$34,415.30
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$34,415.30 |
| Max. Negotiated Rate |
$34,415.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,415.30
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$34,415.30
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$34,415.30 |
| Max. Negotiated Rate |
$34,415.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,415.30
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$34,415.30
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$34,415.30 |
| Max. Negotiated Rate |
$34,415.30 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,415.30
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$245,292.00
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$245,292.00 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$245,292.00
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$245,292.00
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$245,292.00 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$245,292.00
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
