|
HC INSERT TUNNELED CV CATH WITH PORT
|
Facility
|
IP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
3613656101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,647.10 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
|
|
HC INSERT TUNNELED CV CATH W/O PORT OR PUMP
|
Facility
|
OP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
3613655801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| 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 |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,891.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,103.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,730.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INSERT TUNNELED CV CATH W/O PORT OR PUMP
|
Facility
|
IP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
3613655801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,647.10 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
|
|
HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Facility
|
OP
|
$21,513.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
3613719101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$20,867.61 |
| Rate for Payer: AlohaCare Medicaid |
$6,573.58
|
| Rate for Payer: AlohaCare Medicare |
$6,573.58
|
| Rate for Payer: Cash Price |
$12,907.80
|
| Rate for Payer: Cash Price |
$12,907.80
|
| Rate for Payer: Cash Price |
$12,907.80
|
| Rate for Payer: Devoted Health Medicare |
$7,230.94
|
| 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 |
$6,573.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$18,286.05
|
| Rate for Payer: Humana Medicare |
$6,573.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$13,553.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,573.58
|
| Rate for Payer: MDX Hawaii PPO |
$20,867.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,230.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,573.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,573.58
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I
|
Facility
|
IP
|
$21,513.00
|
|
|
Service Code
|
HCPCS 37191
|
| Hospital Charge Code |
3613719101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,286.05 |
| Max. Negotiated Rate |
$20,867.61 |
| Rate for Payer: Cash Price |
$12,907.80
|
| Rate for Payer: Health Management Network Commercial |
$18,286.05
|
| Rate for Payer: MDX Hawaii PPO |
$20,867.61
|
|
|
HC IN SITU HYBRID EA ADD
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
3108836401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$728.47 |
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$713.45
|
| Rate for Payer: Health Management Network Commercial |
$638.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$473.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$383.01
|
| Rate for Payer: MDX Hawaii PPO |
$728.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.48
|
| Rate for Payer: University Health Alliance Commercial |
$203.04
|
|
|
HC IN SITU HYBRID EA ADD
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
3108836401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$638.35 |
| Max. Negotiated Rate |
$728.47 |
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Health Management Network Commercial |
$638.35
|
| Rate for Payer: MDX Hawaii PPO |
$728.47
|
|
|
HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Facility
|
OP
|
$38,350.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
7613322501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$37,199.50 |
| Rate for Payer: Cash Price |
$23,010.00
|
| Rate for Payer: Cash Price |
$23,010.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36,432.50
|
| Rate for Payer: Health Management Network Commercial |
$32,597.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$24,160.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19,558.50
|
| Rate for Payer: MDX Hawaii PPO |
$37,199.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.55
|
| Rate for Payer: University Health Alliance Commercial |
$27,953.31
|
|
|
HC INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Facility
|
IP
|
$38,350.00
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
7613322501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32,597.50 |
| Max. Negotiated Rate |
$37,199.50 |
| Rate for Payer: Cash Price |
$23,010.00
|
| Rate for Payer: Health Management Network Commercial |
$32,597.50
|
| Rate for Payer: MDX Hawaii PPO |
$37,199.50
|
|
|
HC INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY
|
Facility
|
OP
|
$12,870.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
3603399001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.11 |
| Max. Negotiated Rate |
$12,483.90 |
| Rate for Payer: Cash Price |
$7,722.00
|
| Rate for Payer: Cash Price |
$7,722.00
|
| Rate for Payer: Cash Price |
$7,722.00
|
| Rate for Payer: Health Management Network Commercial |
$10,939.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,108.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: MDX Hawaii PPO |
$12,483.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$262.11
|
| Rate for Payer: University Health Alliance Commercial |
$9,380.94
|
|
|
HC INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY
|
Facility
|
IP
|
$12,870.00
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
3603399001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,939.50 |
| Max. Negotiated Rate |
$12,483.90 |
| Rate for Payer: Cash Price |
$7,722.00
|
| Rate for Payer: Health Management Network Commercial |
$10,939.50
|
| Rate for Payer: MDX Hawaii PPO |
$12,483.90
|
|
|
HC INSTILL ANTICANCER AGENT IN BLADDER
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
3615172001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.68 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$823.75
|
| Rate for Payer: AlohaCare Medicare |
$823.75
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Devoted Health Medicare |
$906.12
|
| 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 |
$823.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Humana Medicare |
$823.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,673.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$823.75
|
| Rate for Payer: MDX Hawaii PPO |
$2,576.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$906.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$823.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$823.75
|
| Rate for Payer: University Health Alliance Commercial |
$1,935.96
|
|
|
HC INSTILL ANTICANCER AGENT IN BLADDER
|
Facility
|
IP
|
$2,656.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
3615172001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,257.60 |
| Max. Negotiated Rate |
$2,576.32 |
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,576.32
|
|
|
HC INSULIN ANTIBODIES - INSULIN ANTIBODY
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
3028633701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$21.41
|
| Rate for Payer: AlohaCare Medicare |
$21.41
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Devoted Health Medicare |
$23.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.41
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$21.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.41
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.41
|
| Rate for Payer: University Health Alliance Commercial |
$55.35
|
|
|
HC INSULIN ANTIBODIES - INSULIN ANTIBODY
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
3028633701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 12.6 TO 20.0 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
4501204501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$2,362.92 |
| 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: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$960.41
|
| 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 |
$873.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| 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 |
$937.50
|
| 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 Medicare |
$873.10
|
| Rate for Payer: University Health Alliance Commercial |
$1,775.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 12.6 TO 20.0 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
4501204501
|
|
Hospital Revenue Code
|
450
|
| 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 INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
4501204601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,362.92 |
| 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: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$960.41
|
| 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 |
$873.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| 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 |
$937.50
|
| 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 INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
4501204601
|
|
Hospital Revenue Code
|
450
|
| 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 INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
OP
|
$7,128.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
4501204701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,914.16 |
| Rate for Payer: AlohaCare Medicaid |
$2,437.45
|
| Rate for Payer: AlohaCare Medicare |
$2,437.45
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Devoted Health Medicare |
$2,681.20
|
| 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 |
$2,437.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,771.60
|
| Rate for Payer: Health Management Network Commercial |
$6,058.80
|
| Rate for Payer: Humana Medicare |
$2,437.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,490.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,437.45
|
| Rate for Payer: MDX Hawaii PPO |
$6,914.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,681.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,437.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,437.45
|
| Rate for Payer: University Health Alliance Commercial |
$5,195.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
IP
|
$7,128.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
4501204701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,058.80 |
| Max. Negotiated Rate |
$6,914.16 |
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Health Management Network Commercial |
$6,058.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,914.16
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, TRUNK, AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
OP
|
$7,280.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
4501203701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,061.60 |
| Rate for Payer: AlohaCare Medicaid |
$2,437.45
|
| Rate for Payer: AlohaCare Medicare |
$2,437.45
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Devoted Health Medicare |
$2,681.20
|
| 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 |
$2,437.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,916.00
|
| Rate for Payer: Health Management Network Commercial |
$6,188.00
|
| Rate for Payer: Humana Medicare |
$2,437.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,586.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,437.45
|
| Rate for Payer: MDX Hawaii PPO |
$7,061.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,681.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,437.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,437.45
|
| Rate for Payer: University Health Alliance Commercial |
$5,306.39
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, TRUNK, AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
IP
|
$7,280.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
4501203701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,188.00 |
| Max. Negotiated Rate |
$7,061.60 |
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Health Management Network Commercial |
$6,188.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,061.60
|
|
|
HC INTRAOP CYTO PATH CONSULT 2 - LAB INTRAOPERATIVE CYTO PATH CONSULT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 88334 TC
|
| Hospital Charge Code |
3128833401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.97
|
| Rate for Payer: University Health Alliance Commercial |
$37.07
|
|
|
HC INTRAOP CYTO PATH CONSULT 2 - LAB INTRAOPERATIVE CYTO PATH CONSULT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 88334 TC
|
| Hospital Charge Code |
3128833401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|