|
COVER TIP ACCESSORY 400180
|
Facility
|
IP
|
$126.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
CRANIAL ACCESS KIT 82-6614
|
Facility
|
OP
|
$1,665.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$849.15 |
| Max. Negotiated Rate |
$1,615.05 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,581.75
|
| Rate for Payer: Health Management Network Commercial |
$1,415.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,048.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$849.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,615.05
|
| Rate for Payer: University Health Alliance Commercial |
$1,213.62
|
|
|
CRANIAL ACCESS KIT 82-6614
|
Facility
|
IP
|
$1,665.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,415.25 |
| Max. Negotiated Rate |
$1,615.05 |
| Rate for Payer: Cash Price |
$999.00
|
| Rate for Payer: Health Management Network Commercial |
$1,415.25
|
| Rate for Payer: MDX Hawaii PPO |
$1,615.05
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$27,674.17
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$18,247.71 |
| Max. Negotiated Rate |
$27,674.17 |
| Rate for Payer: AlohaCare Medicare |
$18,247.71
|
| Rate for Payer: Devoted Health Medicare |
$20,072.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25,091.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18,247.71
|
| Rate for Payer: Humana Medicare |
$18,247.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$27,674.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$18,247.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$18,247.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$18,247.71
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$22,858.57
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$11,724.58 |
| Max. Negotiated Rate |
$22,858.57 |
| Rate for Payer: AlohaCare Medicare |
$11,724.58
|
| Rate for Payer: Devoted Health Medicare |
$12,897.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,858.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11,724.58
|
| Rate for Payer: Humana Medicare |
$11,724.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,781.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$11,724.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$11,724.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$11,724.58
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$91,215.89
|
|
|
Service Code
|
MSDRG 026
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$91,215.89 |
| Rate for Payer: AlohaCare Medicare |
$35,364.83
|
| Rate for Payer: Devoted Health Medicare |
$38,901.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91,215.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35,364.83
|
| Rate for Payer: Humana Medicare |
$35,364.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$53,633.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$35,364.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$35,364.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$35,364.83
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$91,215.89
|
|
|
Service Code
|
MSDRG 025
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$91,215.89 |
| Rate for Payer: AlohaCare Medicare |
$51,715.32
|
| Rate for Payer: Devoted Health Medicare |
$56,886.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91,215.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51,715.32
|
| Rate for Payer: Humana Medicare |
$51,715.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$78,430.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$51,715.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$51,715.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$51,715.32
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$78,476.24
|
|
|
Service Code
|
MSDRG 027
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$78,476.24 |
| Rate for Payer: AlohaCare Medicare |
$28,696.11
|
| Rate for Payer: Devoted Health Medicare |
$31,565.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$78,476.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28,696.11
|
| Rate for Payer: Humana Medicare |
$28,696.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$43,520.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$28,696.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$28,696.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$28,696.11
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$16,314.33
|
|
|
Service Code
|
APR-DRG 9102
|
| Min. Negotiated Rate |
$16,314.33 |
| Max. Negotiated Rate |
$16,314.33 |
| Rate for Payer: AlohaCare Medicaid |
$16,314.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16,314.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16,314.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16,314.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16,314.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16,314.33
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$12,549.48
|
|
|
Service Code
|
APR-DRG 9101
|
| Min. Negotiated Rate |
$12,549.48 |
| Max. Negotiated Rate |
$12,549.48 |
| Rate for Payer: AlohaCare Medicaid |
$12,549.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12,549.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12,549.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12,549.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12,549.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12,549.48
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$22,783.35
|
|
|
Service Code
|
APR-DRG 9103
|
| Min. Negotiated Rate |
$22,783.35 |
| Max. Negotiated Rate |
$22,783.35 |
| Rate for Payer: AlohaCare Medicaid |
$22,783.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22,783.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22,783.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22,783.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22,783.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22,783.35
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$41,163.51
|
|
|
Service Code
|
APR-DRG 9104
|
| Min. Negotiated Rate |
$41,163.51 |
| Max. Negotiated Rate |
$41,163.51 |
| Rate for Payer: AlohaCare Medicaid |
$41,163.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41,163.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41,163.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41,163.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41,163.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41,163.51
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$230,211.54
|
|
|
Service Code
|
MSDRG 955
|
| Min. Negotiated Rate |
$76,561.25 |
| Max. Negotiated Rate |
$230,211.54 |
| Rate for Payer: AlohaCare Medicare |
$76,561.25
|
| Rate for Payer: Devoted Health Medicare |
$84,217.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230,211.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76,561.25
|
| Rate for Payer: Humana Medicare |
$76,561.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$116,111.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$76,561.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$76,561.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$76,561.25
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$107,352.78
|
|
|
Service Code
|
MSDRG 023
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$107,352.78 |
| Rate for Payer: AlohaCare Medicare |
$65,177.90
|
| Rate for Payer: Devoted Health Medicare |
$71,695.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107,352.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65,177.90
|
| Rate for Payer: Humana Medicare |
$65,177.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$98,847.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$65,177.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$65,177.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$65,177.90
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$102,305.46
|
|
|
Service Code
|
MSDRG 024
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$102,305.46 |
| Rate for Payer: AlohaCare Medicare |
$44,494.95
|
| Rate for Payer: Devoted Health Medicare |
$48,944.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102,305.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44,494.95
|
| Rate for Payer: Humana Medicare |
$44,494.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$67,480.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$44,494.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$44,494.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$44,494.95
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
CR ARTCLR SURF 00-5964-040-12
|
Facility
|
IP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,569.68 |
| Max. Negotiated Rate |
$2,718.91 |
| Rate for Payer: Cash Price |
$1,681.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,962.10
|
| Rate for Payer: Health Management Network Commercial |
$2,382.55
|
| Rate for Payer: MDX Hawaii PPO |
$2,718.91
|
| Rate for Payer: University Health Alliance Commercial |
$1,569.68
|
|
|
CR ARTCLR SURF 00-5964-040-12
|
Facility
|
OP
|
$2,803.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.53 |
| Max. Negotiated Rate |
$2,718.91 |
| Rate for Payer: Cash Price |
$1,681.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,962.10
|
| Rate for Payer: Health Management Network Commercial |
$2,382.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,765.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,429.53
|
| Rate for Payer: MDX Hawaii PPO |
$2,718.91
|
| Rate for Payer: University Health Alliance Commercial |
$1,569.68
|
|
|
CRCLG PASSER LF OFFST AR-7824L
|
Facility
|
OP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.77 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,070.65
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$710.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$574.77
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
| Rate for Payer: University Health Alliance Commercial |
$821.47
|
|
|
CRCLG PASSER LF OFFST AR-7824L
|
Facility
|
IP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
|
|
CRCLG PASSER RT OFFST AR-7824R
|
Facility
|
IP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
|
|
CRCLG PASSER RT OFFST AR-7824R
|
Facility
|
OP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.77 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,070.65
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$710.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$574.77
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
| Rate for Payer: University Health Alliance Commercial |
$821.47
|
|
|
CRCLG PASSER TROCH AR-7823
|
Facility
|
OP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.77 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,070.65
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$710.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$574.77
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
| Rate for Payer: University Health Alliance Commercial |
$821.47
|
|
|
CRCLG PASSER TROCH AR-7823
|
Facility
|
IP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
|
|
CRCLG STR PASSER LG AR-7822
|
Facility
|
IP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
|
|
CRCLG STR PASSER LG AR-7822
|
Facility
|
OP
|
$1,127.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$574.77 |
| Max. Negotiated Rate |
$1,093.19 |
| Rate for Payer: Cash Price |
$676.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,070.65
|
| Rate for Payer: Health Management Network Commercial |
$957.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$710.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$574.77
|
| Rate for Payer: MDX Hawaii PPO |
$1,093.19
|
| Rate for Payer: University Health Alliance Commercial |
$821.47
|
|
