|
HC CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
4502362501
|
|
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 CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
4502724001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$710.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$710.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
4502724001
|
|
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 TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
4502450001
|
|
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 TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
4502450001
|
|
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 TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF KNEE, WITH OR WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
4502753801
|
|
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 TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF KNEE, WITH OR WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
4502753801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$710.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$710.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE; WITH ANESTHESIA
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 28665
|
| Hospital Charge Code |
4502866501
|
|
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 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE; WITH ANESTHESIA
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 28665
|
| Hospital Charge Code |
4502866501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$4,035.20
|
|
|
HC CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE; WITHOUT ANESTHESIA
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 28635
|
| Hospital Charge Code |
4502863501
|
|
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 TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE; WITHOUT ANESTHESIA
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 28635
|
| Hospital Charge Code |
4502863501
|
|
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 TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
4502723801
|
|
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 CLOSED TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
4502723801
|
|
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 Medicare |
$4,739.36
|
| Rate for Payer: University Health Alliance Commercial |
$4,545.42
|
|
|
HC CLOSED TREATMENT OF LUNATE DISLOCATION; WITH MANIPULATION
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
4502569001
|
|
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 CLOSED TREATMENT OF LUNATE DISLOCATION; WITH MANIPULATION
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
4502569001
|
|
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 CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 21450
|
| Hospital Charge Code |
4502145001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,966.19 |
| Rate for Payer: AlohaCare Medicaid |
$1,013.50
|
| Rate for Payer: AlohaCare Medicare |
$1,540.52
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Devoted Health Medicare |
$1,702.68
|
| 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 |
$1,540.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,925.65
|
| Rate for Payer: Health Management Network Commercial |
$1,722.95
|
| Rate for Payer: Humana Medicare |
$1,540.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,824.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,540.52
|
| Rate for Payer: MDX Hawaii PPO |
$1,966.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,540.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,540.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,540.52
|
| Rate for Payer: University Health Alliance Commercial |
$1,477.48
|
|
|
HC CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 21450
|
| Hospital Charge Code |
4502145001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,722.95 |
| Max. Negotiated Rate |
$1,966.19 |
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Health Management Network Commercial |
$1,722.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,824.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,966.19
|
|
|
HC CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
4502847501
|
|
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 TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
4502847501
|
|
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 TREATMENT OF METATARSOPHALANGEAL DISLOCATION; WITH MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
4502854001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$710.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$710.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL DISLOCATION; WITH MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
4502854001
|
|
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 TREATMENT OF METATARSOPHALANGEAL DISLOCATION; WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
4502853001
|
|
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 TREATMENT OF METATARSOPHALANGEAL DISLOCATION; WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
4502853001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$710.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$710.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, SINGLE; WITH ANESTHESIA
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
4502860501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$710.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$710.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION, SINGLE; WITH ANESTHESIA
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 28605
|
| Hospital Charge Code |
4502860501
|
|
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
|
|
