|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL DISLOCATION; WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
4502853001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, SINGLE; WITH ANESTHESIA
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
4502860501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, SINGLE; WITH ANESTHESIA
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
4502860501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, SINGLE; WITHOUT ANESTHESIA
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
4502860001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, SINGLE; WITHOUT ANESTHESIA
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
4502860001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 21345
|
| Hospital Charge Code |
4502134501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,906.20 |
| Max. Negotiated Rate |
$5,598.84 |
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Health Management Network Commercial |
$4,906.20
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
|
|
HC CLOSED TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 21345
|
| Hospital Charge Code |
4502134501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,832.96
|
| Rate for Payer: AlohaCare Medicare |
$1,832.96
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Devoted Health Medicare |
$2,016.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,832.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,483.40
|
| Rate for Payer: Health Management Network Commercial |
$4,906.20
|
| Rate for Payer: Humana Medicare |
$1,832.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,636.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,832.96
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,016.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,832.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,832.96
|
| Rate for Payer: University Health Alliance Commercial |
$16,700.00
|
|
|
HC CLOSED TREATMENT OF PATELLAR DISLOCATION, WITH ANESTHESIA
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
4502756201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$811.75 |
| Max. Negotiated Rate |
$926.35 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED TREATMENT OF PATELLAR DISLOCATION, WITH ANESTHESIA
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
4502756201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
4502752001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$811.75 |
| Max. Negotiated Rate |
$926.35 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED TREATMENT OF PATELLAR FRACTURE, WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
4502752001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED TREATMENT OF PHALANGEAL FRACTURE, TOE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
4502849001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC CLOSED TREATMENT OF PHALANGEAL FRACTURE, TOE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
4502849001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$811.75 |
| Max. Negotiated Rate |
$926.35 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
4502776801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,050.55
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,012.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
4502776801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,413.65 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
4502776701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
4502776701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF POSTERIOR PELVIC RING FRACTURE(S), DISLOCATION(S), DIASTASIS OR SUBLUXATION OF THE ILIUM, SACROILIAC JOINT, AND/OR SACRUM, WITH MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27198
|
| Hospital Charge Code |
4502719801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF POSTERIOR PELVIC RING FRACTURE(S), DISLOCATION(S), DIASTASIS OR SUBLUXATION OF THE ILIUM, SACROILIAC JOINT, AND/OR SACRUM, WITH MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27198
|
| Hospital Charge Code |
4502719801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED TREATMENT OF POSTERIOR PELVIC RING FRACTURE(S), DISLOCATION(S), DIASTASIS OR SUBLUXATION OF THE ILIUM, SACROILIAC JOINT, AND/OR SACRUM, WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
4502719701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED TREATMENT OF POSTERIOR PELVIC RING FRACTURE(S), DISLOCATION(S), DIASTASIS OR SUBLUXATION OF THE ILIUM, SACROILIAC JOINT, AND/OR SACRUM, WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
4502719701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
4502778001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
4502778001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
4502556001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
4502556001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$811.75 |
| Max. Negotiated Rate |
$926.35 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
