|
HC IMMUNOHISTOCHEM EA MULT
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,029.40 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
|
|
HC IMPLANTABLE DEFIB EVAL DUAL - IN PERSON
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
4809328301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$44.09
|
| Rate for Payer: AlohaCare Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.09
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.09
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
HC IMPLANTABLE DEFIB EVAL DUAL - IN PERSON
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
4809328301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HC IMPLANTABLE DEFIB EVAL MULTI - IN PERSON
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 93284
|
| Hospital Charge Code |
4809328401
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$44.09
|
| Rate for Payer: AlohaCare Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.09
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.09
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
HC IMPLANTABLE DEFIB EVAL MULTI - IN PERSON
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 93284
|
| Hospital Charge Code |
4809328401
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HC IMPLANTABLE DEFIB EVAL SINGLE - IN PERSON
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
4809328201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$44.09
|
| Rate for Payer: AlohaCare Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.09
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.09
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
HC IMPLANTABLE DEFIB EVAL SINGLE - IN PERSON
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
4809328201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HC IMPLANTABLE DEFIB INTERROGATE - IN PERSON
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 93289
|
| Hospital Charge Code |
4809328901
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$44.09
|
| Rate for Payer: AlohaCare Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.09
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.09
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
HC IMPLANTABLE DEFIB INTERROGATE - IN PERSON
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 93289
|
| Hospital Charge Code |
4809328901
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HC IMRT PLAN
|
Facility
|
OP
|
$6,094.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
3337730101
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$781.61 |
| Max. Negotiated Rate |
$5,911.18 |
| Rate for Payer: AlohaCare Medicaid |
$1,635.14
|
| Rate for Payer: AlohaCare Medicare |
$1,635.14
|
| Rate for Payer: Cash Price |
$3,656.40
|
| Rate for Payer: Cash Price |
$3,656.40
|
| Rate for Payer: Devoted Health Medicare |
$1,798.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$781.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,043.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,635.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$999.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,635.14
|
| Rate for Payer: Health Management Network Commercial |
$5,179.90
|
| Rate for Payer: Humana Medicare |
$1,635.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,839.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,107.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,635.14
|
| Rate for Payer: MDX Hawaii PPO |
$5,911.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,798.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,635.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$781.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,635.14
|
| Rate for Payer: University Health Alliance Commercial |
$4,116.93
|
|
|
HC IMRT PLAN
|
Facility
|
IP
|
$6,094.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
3337730101
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,179.90 |
| Max. Negotiated Rate |
$5,911.18 |
| Rate for Payer: Cash Price |
$3,656.40
|
| Rate for Payer: Health Management Network Commercial |
$5,179.90
|
| Rate for Payer: MDX Hawaii PPO |
$5,911.18
|
|
|
HC INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
7614270001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.33 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$279.80
|
| Rate for Payer: AlohaCare Medicare |
$279.80
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$307.78
|
| 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 |
$279.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$279.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$582.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$471.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.80
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.80
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
7614270001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
7615470001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: AlohaCare Medicaid |
$2,469.46
|
| Rate for Payer: AlohaCare Medicare |
$2,469.46
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Devoted Health Medicare |
$2,716.41
|
| 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 |
$2,469.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,744.40
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: Humana Medicare |
$2,469.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,135.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,469.46
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,716.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,469.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,469.46
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
7615470001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,929.20 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
HCPCS 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,177.66
|
| Rate for Payer: AlohaCare Medicare |
$1,177.66
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Devoted Health Medicare |
$1,295.43
|
| 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 |
$1,177.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,585.30
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Humana Medicare |
$1,177.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,377.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.66
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,295.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.66
|
| Rate for Payer: University Health Alliance Commercial |
$2,750.87
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
HCPCS 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,207.90 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
|
|
HC INCISE EXTERNAL HEMORRHOID
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
4504608301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.16 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$295.16
|
| Rate for Payer: AlohaCare Medicare |
$295.16
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Devoted Health Medicare |
$324.68
|
| 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 |
$295.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$919.60
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Humana Medicare |
$295.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.16
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.16
|
| Rate for Payer: University Health Alliance Commercial |
$705.58
|
|
|
HC INCISE EXTERNAL HEMORRHOID
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
4504608301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$822.80 |
| Max. Negotiated Rate |
$938.96 |
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
3611110601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$873.10
|
| Rate for Payer: AlohaCare Medicare |
$873.10
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$960.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,091.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$873.10
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$873.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,534.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$873.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$960.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$873.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$873.10
|
| Rate for Payer: University Health Alliance Commercial |
$1,775.60
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
3611110601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC INCISION AND DRAINAGE, BURSA, FOOT
|
Facility
|
OP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 28001
|
| Hospital Charge Code |
4502800101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,998.30
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,977.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,602.27
|
|
|
HC INCISION AND DRAINAGE, BURSA, FOOT
|
Facility
|
IP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 28001
|
| Hospital Charge Code |
4502800101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,366.90 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, FOREARM AND/OR WRIST
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
4502502801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$12,524.64 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| 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 |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,266.40
|
| Rate for Payer: Health Management Network Commercial |
$10,975.20
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,134.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: MDX Hawaii PPO |
$12,524.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, FOREARM AND/OR WRIST
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
4502502801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,975.20 |
| Max. Negotiated Rate |
$12,524.64 |
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Health Management Network Commercial |
$10,975.20
|
| Rate for Payer: MDX Hawaii PPO |
$12,524.64
|
|
