|
HC APPLY LONG LEG CAST,WALKER
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 29355
|
| Hospital Charge Code |
7002935501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$517.50
|
| Rate for Payer: AlohaCare Medicare |
$786.60
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Devoted Health Medicare |
$869.40
|
| 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 |
$786.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$983.25
|
| Rate for Payer: Health Management Network Commercial |
$879.75
|
| Rate for Payer: Humana Medicare |
$786.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$931.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$786.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,003.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$786.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$786.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$786.60
|
| Rate for Payer: University Health Alliance Commercial |
$754.41
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
7002951501
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$609.16 |
| 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 Commercial |
$207.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$477.28
|
| 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 |
$320.28
|
| 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 Medicaid |
$29.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$477.28
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC APPLY LOWER LEG SPLINT
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
7002951501
|
|
Hospital Revenue Code
|
700
|
| 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 SHORT LEG CAST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
7002940501
|
|
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 SHORT LEG CAST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
7002940501
|
|
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 SHORT LEG CAST,WALKER
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
7002942501
|
|
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 SHORT LEG CAST,WALKER
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
7002942501
|
|
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 ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION; CUTDOWN
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
4503662501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.90 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.60
|
| Rate for Payer: MDX Hawaii PPO |
$246.38
|
|
|
HC ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION; CUTDOWN
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
4503662501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$127.00
|
| Rate for Payer: AlohaCare Medicare |
$193.04
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Devoted Health Medicare |
$213.36
|
| 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 |
$193.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.30
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Humana Medicare |
$193.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.04
|
| Rate for Payer: MDX Hawaii PPO |
$246.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$193.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.04
|
| Rate for Payer: University Health Alliance Commercial |
$185.14
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
IP
|
$2,756.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
7612060601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,342.60 |
| Max. Negotiated Rate |
$2,673.32 |
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Health Management Network Commercial |
$2,342.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,480.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,673.32
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
OP
|
$2,756.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
7612060601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,673.32 |
| Rate for Payer: AlohaCare Medicaid |
$1,378.00
|
| Rate for Payer: AlohaCare Medicare |
$2,094.56
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Devoted Health Medicare |
$2,315.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$901.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,094.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,618.20
|
| Rate for Payer: Health Management Network Commercial |
$2,342.60
|
| Rate for Payer: Humana Medicare |
$2,094.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,480.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,405.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,094.56
|
| Rate for Payer: MDX Hawaii PPO |
$2,673.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,094.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,094.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,094.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,008.85
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3612061001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$998.75 |
| Max. Negotiated Rate |
$1,139.75 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
3612061001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$587.50
|
| Rate for Payer: AlohaCare Medicare |
$893.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Devoted Health Medicare |
$987.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$893.00
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Humana Medicare |
$893.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
7612061101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$998.75 |
| Max. Negotiated Rate |
$1,139.75 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
7612061101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$587.50
|
| Rate for Payer: AlohaCare Medicare |
$893.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Devoted Health Medicare |
$987.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$893.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,116.25
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Humana Medicare |
$893.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$599.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$587.50
|
| Rate for Payer: AlohaCare Medicare |
$893.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Devoted Health Medicare |
$987.00
|
| 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 |
$893.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,116.25
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Humana Medicare |
$893.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.00
|
| Rate for Payer: University Health Alliance Commercial |
$856.46
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$998.75 |
| Max. Negotiated Rate |
$1,139.75 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
3612061201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$587.50
|
| Rate for Payer: AlohaCare Medicare |
$893.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Devoted Health Medicare |
$987.00
|
| 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 |
$893.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,116.25
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Humana Medicare |
$893.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.00
|
| Rate for Payer: University Health Alliance Commercial |
$856.46
|
|
|
HC ASPIRAT/INJECTION GANGLION CYST(S)
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
3612061201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$998.75 |
| Max. Negotiated Rate |
$1,139.75 |
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Health Management Network Commercial |
$998.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,057.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,139.75
|
|
|
HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
3615110201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: AlohaCare Medicaid |
$4,076.00
|
| Rate for Payer: AlohaCare Medicare |
$6,195.52
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Devoted Health Medicare |
$6,847.68
|
| 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 |
$6,195.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$6,195.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,336.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,195.52
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,195.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,195.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,195.52
|
| Rate for Payer: University Health Alliance Commercial |
$5,941.99
|
|
|
HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
3615110201
|
|
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: Kaiser Permanente Commercial |
$7,336.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
|
|
HC ASPIRATION OF BLADDER; BY NEEDLE
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS 51100
|
| Hospital Charge Code |
4505110001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$474.00
|
| Rate for Payer: AlohaCare Medicare |
$720.48
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Devoted Health Medicare |
$796.32
|
| 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 |
$720.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$900.60
|
| Rate for Payer: Health Management Network Commercial |
$805.80
|
| Rate for Payer: Humana Medicare |
$720.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$853.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$720.48
|
| Rate for Payer: MDX Hawaii PPO |
$919.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$720.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$720.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$720.48
|
| Rate for Payer: University Health Alliance Commercial |
$691.00
|
|
|
HC ASPIRATION OF BLADDER; BY NEEDLE
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS 51100
|
| Hospital Charge Code |
4505110001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$805.80 |
| Max. Negotiated Rate |
$919.56 |
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Management Network Commercial |
$805.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$853.20
|
| Rate for Payer: MDX Hawaii PPO |
$919.56
|
|
|
HC ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER
|
Facility
|
IP
|
$3,965.00
|
|
|
Service Code
|
HCPCS 51101
|
| Hospital Charge Code |
4505110101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,370.25 |
| Max. Negotiated Rate |
$3,846.05 |
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Health Management Network Commercial |
$3,370.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,568.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,846.05
|
|
|
HC ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER
|
Facility
|
OP
|
$3,965.00
|
|
|
Service Code
|
HCPCS 51101
|
| Hospital Charge Code |
4505110101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,846.05 |
| Rate for Payer: AlohaCare Medicaid |
$1,982.50
|
| Rate for Payer: AlohaCare Medicare |
$3,013.40
|
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Cash Price |
$2,379.00
|
| Rate for Payer: Devoted Health Medicare |
$3,330.60
|
| 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 |
$3,013.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,766.75
|
| Rate for Payer: Health Management Network Commercial |
$3,370.25
|
| Rate for Payer: Humana Medicare |
$3,013.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,568.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,013.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,846.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,013.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,013.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,013.40
|
| Rate for Payer: University Health Alliance Commercial |
$2,890.09
|
|
