|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE SO
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$61.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.48
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.48
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE SO
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$84.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$76.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.76
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.76
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC APP FINGER SPLINT DYNM
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4202913101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC APP FINGER SPLINT DYNM
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4202913101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$179.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$198.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$179.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.36
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 20660
|
| Hospital Charge Code |
4502066001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: AlohaCare Medicaid |
$3,118.00
|
| Rate for Payer: AlohaCare Medicare |
$4,739.36
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Devoted Health Medicare |
$5,238.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,739.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,924.20
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Humana Medicare |
$4,739.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,739.36
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,739.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,739.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,739.36
|
| Rate for Payer: University Health Alliance Commercial |
$4,545.42
|
|
|
HC APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 20660
|
| Hospital Charge Code |
4502066001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,300.60 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$314.00
|
| Rate for Payer: AlohaCare Medicare |
$477.28
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$527.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$477.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$477.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.28
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$477.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$477.28
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND); STATIC
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
4502908601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.75 |
| Max. Negotiated Rate |
$596.55 |
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.50
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND); STATIC
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
4502908601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$307.50
|
| Rate for Payer: AlohaCare Medicare |
$467.40
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Devoted Health Medicare |
$516.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$467.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$584.25
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Humana Medicare |
$467.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$467.40
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$467.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$467.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$467.40
|
| Rate for Payer: University Health Alliance Commercial |
$448.27
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7002913001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: AlohaCare Medicaid |
$346.50
|
| Rate for Payer: AlohaCare Medicare |
$526.68
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Devoted Health Medicare |
$582.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$526.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$658.35
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: Humana Medicare |
$526.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$353.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$526.68
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$526.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$526.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$526.68
|
| Rate for Payer: University Health Alliance Commercial |
$505.13
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7002913001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$589.05 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.70
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$898.45 |
| Max. Negotiated Rate |
$1,025.29 |
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$528.50
|
| Rate for Payer: AlohaCare Medicare |
$803.32
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Devoted Health Medicare |
$887.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$803.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.15
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Humana Medicare |
$803.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$803.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$803.32
|
| Rate for Payer: University Health Alliance Commercial |
$770.45
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
7002912501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$389.88
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$430.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$389.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$261.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.88
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.88
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC APPLY FOREARM SPLINT,STATIC
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
7002912501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
7002906501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$898.45 |
| Max. Negotiated Rate |
$1,025.29 |
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
|
|
HC APPLY LONG ARM CAST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
7002906501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$528.50
|
| Rate for Payer: AlohaCare Medicare |
$803.32
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Devoted Health Medicare |
$887.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$803.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.15
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Humana Medicare |
$803.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$803.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$803.32
|
| Rate for Payer: University Health Alliance Commercial |
$770.45
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4502910501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$314.00
|
| Rate for Payer: AlohaCare Medicare |
$477.28
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$527.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$477.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$477.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.28
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$477.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$477.28
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC APPLY LONG ARM SPLINT
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
4502910501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC APPLY LONG LEG CAST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
7002934501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$898.45 |
| Max. Negotiated Rate |
$1,025.29 |
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
|
|
HC APPLY LONG LEG CAST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
7002934501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$528.50
|
| Rate for Payer: AlohaCare Medicare |
$803.32
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Devoted Health Medicare |
$887.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$803.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.15
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Humana Medicare |
$803.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$803.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$803.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$803.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$803.32
|
| Rate for Payer: University Health Alliance Commercial |
$770.45
|
|
|
HC APPLY LONG LEG CAST,WALKER
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 29355
|
| Hospital Charge Code |
7002935501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$879.75 |
| Max. Negotiated Rate |
$1,003.95 |
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Health Management Network Commercial |
$879.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$931.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,003.95
|
|
