|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$93,433.28
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$93,433.28 |
| Max. Negotiated Rate |
$93,433.28 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$93,433.28
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,022.52
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$37,022.52 |
| Max. Negotiated Rate |
$37,022.52 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37,022.52
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$10,400.00
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$10,400.00 |
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
pantoprazole 40mg vial [HHSC]
|
Facility
|
OP
|
$51.08
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
2500633
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.54 |
| Max. Negotiated Rate |
$49.55 |
| Rate for Payer: AlohaCare Medicaid |
$25.54
|
| Rate for Payer: AlohaCare Medicaid |
$11.34
|
| Rate for Payer: AlohaCare Medicaid |
$11.68
|
| Rate for Payer: AlohaCare Medicaid |
$19.45
|
| Rate for Payer: AlohaCare Medicaid |
$16.28
|
| Rate for Payer: AlohaCare Medicaid |
$9.91
|
| Rate for Payer: AlohaCare Medicaid |
$23.84
|
| Rate for Payer: AlohaCare Medicare |
$25.54
|
| Rate for Payer: AlohaCare Medicare |
$11.34
|
| Rate for Payer: AlohaCare Medicare |
$23.84
|
| Rate for Payer: AlohaCare Medicare |
$9.91
|
| Rate for Payer: AlohaCare Medicare |
$19.45
|
| Rate for Payer: AlohaCare Medicare |
$11.68
|
| Rate for Payer: AlohaCare Medicare |
$16.28
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$21.16
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Devoted Health Medicare |
$12.84
|
| Rate for Payer: Devoted Health Medicare |
$10.90
|
| Rate for Payer: Devoted Health Medicare |
$21.39
|
| Rate for Payer: Devoted Health Medicare |
$28.09
|
| Rate for Payer: Devoted Health Medicare |
$26.22
|
| Rate for Payer: Devoted Health Medicare |
$12.47
|
| Rate for Payer: Devoted Health Medicare |
$17.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.53
|
| Rate for Payer: Health Management Network Commercial |
$19.28
|
| Rate for Payer: Health Management Network Commercial |
$19.85
|
| Rate for Payer: Health Management Network Commercial |
$40.52
|
| Rate for Payer: Health Management Network Commercial |
$33.06
|
| Rate for Payer: Health Management Network Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$43.42
|
| Rate for Payer: Health Management Network Commercial |
$27.68
|
| Rate for Payer: Humana Medicare |
$25.54
|
| Rate for Payer: Humana Medicare |
$19.45
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Humana Medicare |
$23.84
|
| Rate for Payer: Humana Medicare |
$11.34
|
| Rate for Payer: Humana Medicare |
$11.68
|
| Rate for Payer: Humana Medicare |
$9.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.68
|
| Rate for Payer: MDX Hawaii PPO |
$19.23
|
| Rate for Payer: MDX Hawaii PPO |
$22.00
|
| Rate for Payer: MDX Hawaii PPO |
$22.65
|
| Rate for Payer: MDX Hawaii PPO |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$49.55
|
| Rate for Payer: MDX Hawaii PPO |
$46.24
|
| Rate for Payer: MDX Hawaii PPO |
$31.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.28
|
| Rate for Payer: University Health Alliance Commercial |
$16.53
|
| Rate for Payer: University Health Alliance Commercial |
$37.23
|
| Rate for Payer: University Health Alliance Commercial |
$23.73
|
| Rate for Payer: University Health Alliance Commercial |
$17.02
|
| Rate for Payer: University Health Alliance Commercial |
$14.45
|
| Rate for Payer: University Health Alliance Commercial |
$28.35
|
| Rate for Payer: University Health Alliance Commercial |
$34.75
|
|
|
pantoprazole 40mg vial [HHSC]
|
Facility
|
IP
|
$38.90
|
|
|
Service Code
|
HCPCS J2470
|
| Hospital Charge Code |
2500633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$37.73 |
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$21.16
|
| Rate for Payer: Health Management Network Commercial |
$19.85
|
| Rate for Payer: Health Management Network Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$19.28
|
| Rate for Payer: Health Management Network Commercial |
$27.68
|
| Rate for Payer: Health Management Network Commercial |
$33.06
|
| Rate for Payer: Health Management Network Commercial |
$40.52
|
| Rate for Payer: Health Management Network Commercial |
$43.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.30
|
| Rate for Payer: MDX Hawaii PPO |
$22.00
|
| Rate for Payer: MDX Hawaii PPO |
$31.58
|
| Rate for Payer: MDX Hawaii PPO |
$22.65
|
| Rate for Payer: MDX Hawaii PPO |
$49.55
|
| Rate for Payer: MDX Hawaii PPO |
$46.24
|
| Rate for Payer: MDX Hawaii PPO |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$19.23
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084081309
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 66993006880
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687073609
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
IP
|
$22.39
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
2500634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Health Management Network Commercial |
$19.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.15
|
| Rate for Payer: MDX Hawaii PPO |
$21.72
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687073665
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 66993006880
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687073665
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
OP
|
$22.39
|
|
|
Service Code
|
NDC 50268063915
|
| Hospital Charge Code |
2500634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: AlohaCare Medicaid |
$11.20
|
| Rate for Payer: AlohaCare Medicare |
$11.20
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Devoted Health Medicare |
$12.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.27
|
| Rate for Payer: Health Management Network Commercial |
$19.03
|
| Rate for Payer: Humana Medicare |
$11.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.20
|
| Rate for Payer: MDX Hawaii PPO |
$21.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.20
|
| Rate for Payer: University Health Alliance Commercial |
$16.32
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687073609
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
pantoprazole DR 40 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084081309
|
| Hospital Charge Code |
2500634
|
|
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
|
|
|
Paracentesis w/ Imaging
|
Professional
|
Both
|
$3,755.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
11964775
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$3,191.75 |
| Rate for Payer: AlohaCare Medicaid |
$105.50
|
| Rate for Payer: AlohaCare Medicare |
$92.74
|
| Rate for Payer: Cash Price |
$2,440.75
|
| Rate for Payer: Cash Price |
$2,440.75
|
| Rate for Payer: Devoted Health Medicare |
$102.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.50
|
| Rate for Payer: Health Management Network Commercial |
$3,191.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.74
|
| Rate for Payer: University Health Alliance Commercial |
$140.13
|
|
|
Paracentesis w/ Imaging
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
11964775
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$1,072.70 |
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: AlohaCare Medicaid |
$105.50
|
| Rate for Payer: AlohaCare Medicare |
$92.74
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Devoted Health Medicare |
$102.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Health Management Network Commercial |
$1,072.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$140.13
|
|
|
Paracentesis w/o Imaging
|
Professional
|
Both
|
$2,018.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
11966109
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$1,715.30 |
| Rate for Payer: AlohaCare Medicaid |
$73.51
|
| Rate for Payer: AlohaCare Medicare |
$71.63
|
| Rate for Payer: Cash Price |
$1,311.70
|
| Rate for Payer: Cash Price |
$1,311.70
|
| Rate for Payer: Devoted Health Medicare |
$78.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.76
|
| Rate for Payer: Health Management Network Commercial |
$1,715.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.63
|
|
|
Paracentesis w/o Imaging
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
11966109
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$71.63 |
| Max. Negotiated Rate |
$1,072.70 |
| Rate for Payer: AlohaCare Medicaid |
$73.51
|
| Rate for Payer: AlohaCare Medicare |
$71.63
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Devoted Health Medicare |
$78.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.76
|
| Rate for Payer: Health Management Network Commercial |
$1,072.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
|
|
Paraffin Bath Charge
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 97018 GP
|
| Hospital Charge Code |
8111699
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
|
|
Paraffin Bath Charge
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 97018 GP
|
| Hospital Charge Code |
8111699
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: AlohaCare Medicaid |
$27.50
|
| Rate for Payer: AlohaCare Medicare |
$27.50
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Devoted Health Medicare |
$30.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.25
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Humana Medicare |
$27.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.50
|
| Rate for Payer: University Health Alliance Commercial |
$30.80
|
|
|
Paraffin Bath Charge
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 97018 GP,CQ
|
| Hospital Charge Code |
8123831
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
Paraffin Bath Charge
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 97018 GP,CQ
|
| Hospital Charge Code |
8123831
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$28.00
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Devoted Health Medicare |
$30.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.20
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.00
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.36
|
|
|
Parasite Macroscopic Exam
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
8878773
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: AlohaCare Medicaid |
$26.50
|
| Rate for Payer: AlohaCare Medicare |
$26.50
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Devoted Health Medicare |
$29.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.31
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Humana Medicare |
$26.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.50
|
| Rate for Payer: MDX Hawaii PPO |
$51.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
Parasite Macroscopic Exam
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
8878773
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.70
|
| Rate for Payer: MDX Hawaii PPO |
$51.41
|
|
