|
HC CULT URINE ID
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
3068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HC CULT WOUND
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
3068707003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$54.72
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$60.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$54.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.72
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.72
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HC CULT WOUND
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
3068707003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
|
|
HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
3028620001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$82.84
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$91.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.95
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$82.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.84
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.84
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
3028620001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$184.68
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$204.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.85
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$184.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.68
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.68
|
| Rate for Payer: University Health Alliance Commercial |
$57.11
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP TZANK
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP TZANK
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$184.68
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$204.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.85
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$184.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.68
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.68
|
| Rate for Payer: University Health Alliance Commercial |
$57.11
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP CONVENTIONAL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$116.28
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$128.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.54
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$116.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.28
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.28
|
| Rate for Payer: University Health Alliance Commercial |
$27.31
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP CONVENTIONAL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP DIAGNOSTIC MEDICARE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816402
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$116.28
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$128.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.54
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$116.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.28
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.28
|
| Rate for Payer: University Health Alliance Commercial |
$27.31
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP DIAGNOSTIC MEDICARE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816402
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
HC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88162
|
| Hospital Charge Code |
3118816201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.20
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
|
|
HC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88162
|
| Hospital Charge Code |
3118816201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: AlohaCare Medicaid |
$259.00
|
| Rate for Payer: AlohaCare Medicare |
$393.68
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Devoted Health Medicare |
$435.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Humana Medicare |
$393.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.68
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.68
|
| Rate for Payer: University Health Alliance Commercial |
$153.96
|
|
|
HC CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$180.88
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Devoted Health Medicare |
$199.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.55
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$180.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.88
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.88
|
| Rate for Payer: University Health Alliance Commercial |
$113.20
|
|
|
HC CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
7611104501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$519.50
|
| Rate for Payer: AlohaCare Medicare |
$789.64
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Devoted Health Medicare |
$872.76
|
| 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 |
$789.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$987.05
|
| Rate for Payer: Health Management Network Commercial |
$883.15
|
| Rate for Payer: Humana Medicare |
$789.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$789.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,007.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$789.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$789.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$789.64
|
| Rate for Payer: University Health Alliance Commercial |
$757.33
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
7611104501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.15 |
| Max. Negotiated Rate |
$1,007.83 |
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Health Management Network Commercial |
$883.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,007.83
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7611104301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7611104301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,218.00
|
| Rate for Payer: AlohaCare Medicare |
$1,851.36
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$2,046.24
|
| 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 |
$1,851.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$1,851.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,851.36
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,851.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,851.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,851.36
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
7611104401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$3,224.00
|
| Rate for Payer: AlohaCare Medicare |
$4,900.48
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$5,416.32
|
| 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 |
$4,900.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,125.60
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$4,900.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,900.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,900.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,900.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,900.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,699.95
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
7611104401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$2,374.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
7611104701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,302.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,187.00
|
| Rate for Payer: AlohaCare Medicare |
$1,804.24
|
| Rate for Payer: Cash Price |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,424.40
|
| Rate for Payer: Devoted Health Medicare |
$1,994.16
|
| 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 |
$1,804.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,255.30
|
| Rate for Payer: Health Management Network Commercial |
$2,017.90
|
| Rate for Payer: Humana Medicare |
$1,804.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,136.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,804.24
|
| Rate for Payer: MDX Hawaii PPO |
$2,302.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,804.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,804.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,804.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,730.41
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$2,374.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
7611104701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,017.90 |
| Max. Negotiated Rate |
$2,302.78 |
| Rate for Payer: Cash Price |
$1,424.40
|
| Rate for Payer: Health Management Network Commercial |
$2,017.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,136.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,302.78
|
|
