|
HC CLOSED RX HUMERAL SUPRACONDYLAR FX
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
7612453001
|
|
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: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED RX HUMER CONDYLR FX,MANIP
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
7612457701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED RX HUMER CONDYLR FX,MANIP
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
7612457701
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX HUMER EPICONDYLR FX,MANIP
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
7612456501
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX HUMER EPICONDYLR FX,MANIP
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
7612456501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED RX HUM SUPRACONDYLR FX,MANIPU
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
7612453501
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX HUM SUPRACONDYLR FX,MANIPU
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
7612453501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED RX KNEECAP DISLOCATN
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
4502756001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$477.50
|
| Rate for Payer: AlohaCare Medicare |
$725.80
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$802.20
|
| 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 |
$725.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$725.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.80
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.80
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED RX KNEECAP DISLOCATN
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
4502756001
|
|
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: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED RX KNEE DISLOC+ANESTH
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
7612755201
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX KNEE DISLOC+ANESTH
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
7612755201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC CLOSED RX KNEE DISLOCATN
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
7612755001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$477.50
|
| Rate for Payer: AlohaCare Medicare |
$725.80
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$802.20
|
| 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 |
$725.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$725.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.80
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.80
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED RX KNEE DISLOCATN
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
7612755001
|
|
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: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED RX MANDIBLE FX+MANIPULATN
|
Facility
|
IP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 21451
|
| Hospital Charge Code |
7612145101
|
|
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: Kaiser Permanente Commercial |
$5,194.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
|
|
HC CLOSED RX MANDIBLE FX+MANIPULATN
|
Facility
|
OP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 21451
|
| Hospital Charge Code |
7612145101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,598.84 |
| Rate for Payer: AlohaCare Medicaid |
$2,886.00
|
| Rate for Payer: AlohaCare Medicare |
$4,386.72
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Devoted Health Medicare |
$4,848.48
|
| 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 |
$4,386.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,386.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,194.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,386.72
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,386.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,386.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,386.72
|
| Rate for Payer: University Health Alliance Commercial |
$4,207.21
|
|
|
HC CLOSED RX MED MALLEOLUS FX
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
7612776001
|
|
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: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED RX MED MALLEOLUS FX
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
7612776001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$477.50
|
| Rate for Payer: AlohaCare Medicare |
$725.80
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$802.20
|
| 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 |
$725.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$725.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.80
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.80
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED RX MED MALLEOLUS FX,MANIP
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
7612776201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED RX MED MALLEOLUS FX,MANIP
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
7612776201
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
7612660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$477.50
|
| Rate for Payer: AlohaCare Medicare |
$725.80
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$802.20
|
| 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 |
$725.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$725.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.80
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.80
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED RX METACARPAL FX
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
7612660001
|
|
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: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED RX MID HUMERUS FX,MANIPULATN
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
7612450501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED RX MID HUMERUS FX,MANIPULATN
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
7612450501
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX MONTEGGIA FX/DISLOC ELBOW
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
7612462001
|
|
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: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX MONTEGGIA FX/DISLOC ELBOW
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
7612462001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| 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 |
$4,840.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
