|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
7611104601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$598.50
|
| Rate for Payer: AlohaCare Medicare |
$909.72
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Devoted Health Medicare |
$1,005.48
|
| 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 |
$909.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,137.15
|
| Rate for Payer: Health Management Network Commercial |
$1,017.45
|
| Rate for Payer: Humana Medicare |
$909.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,077.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$909.72
|
| Rate for Payer: MDX Hawaii PPO |
$1,161.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$909.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$909.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$909.72
|
| Rate for Payer: University Health Alliance Commercial |
$872.49
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
7611104601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,017.45 |
| Max. Negotiated Rate |
$1,161.09 |
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Health Management Network Commercial |
$1,017.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,077.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,161.09
|
|
|
HC DILATE ESOPHAGUS - ESOPHAGEAL DILATION
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
7504345001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: AlohaCare Medicaid |
$1,826.50
|
| Rate for Payer: AlohaCare Medicare |
$2,776.28
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Devoted Health Medicare |
$3,068.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,776.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,470.35
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Humana Medicare |
$2,776.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,776.28
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,776.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,776.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,776.28
|
| Rate for Payer: University Health Alliance Commercial |
$2,662.67
|
|
|
HC DILATE ESOPHAGUS - ESOPHAGEAL DILATION
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
7504345001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,105.05 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$57.50
|
| Rate for Payer: AlohaCare Medicare |
$87.40
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Devoted Health Medicare |
$96.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.74
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$87.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.40
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.40
|
| Rate for Payer: University Health Alliance Commercial |
$35.52
|
|
|
HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
4506902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,400.00
|
| Rate for Payer: AlohaCare Medicare |
$2,128.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Devoted Health Medicare |
$2,352.00
|
| 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 |
$2,128.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,660.00
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: Humana Medicare |
$2,128.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,520.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,128.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,716.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,128.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,128.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,128.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,040.92
|
|
|
HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
4506902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,520.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,716.00
|
|
|
HC DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
4504080101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,686.40 |
| Max. Negotiated Rate |
$1,924.48 |
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
|
|
HC DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
4504080101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$992.00
|
| Rate for Payer: AlohaCare Medicare |
$1,507.84
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Devoted Health Medicare |
$1,666.56
|
| 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 |
$1,507.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,884.80
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Humana Medicare |
$1,507.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,507.84
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,507.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,507.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,507.84
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; FLOOR OF MOUTH
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
4504100001
|
|
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 DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; FLOOR OF MOUTH
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
4504100001
|
|
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 DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; SUBMANDIBULAR SPACE
|
Facility
|
IP
|
$12,637.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4504100801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,741.45 |
| Max. Negotiated Rate |
$12,257.89 |
| Rate for Payer: Cash Price |
$7,582.20
|
| Rate for Payer: Health Management Network Commercial |
$10,741.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,373.30
|
| Rate for Payer: MDX Hawaii PPO |
$12,257.89
|
|
|
HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; SUBMANDIBULAR SPACE
|
Facility
|
OP
|
$12,637.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4504100801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,257.89 |
| Rate for Payer: AlohaCare Medicaid |
$6,318.50
|
| Rate for Payer: AlohaCare Medicare |
$9,604.12
|
| Rate for Payer: Cash Price |
$7,582.20
|
| Rate for Payer: Cash Price |
$7,582.20
|
| Rate for Payer: Devoted Health Medicare |
$10,615.08
|
| 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 |
$9,604.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,005.15
|
| Rate for Payer: Health Management Network Commercial |
$10,741.45
|
| Rate for Payer: Humana Medicare |
$9,604.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,373.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,604.12
|
| Rate for Payer: MDX Hawaii PPO |
$12,257.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,604.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,604.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,604.12
|
| Rate for Payer: University Health Alliance Commercial |
$9,211.11
|
|
|
HC DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
4504180001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
4504180001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$389.88
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$430.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$389.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.88
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.88
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC DRAINAGE OF NASAL ABSCESS
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
4503000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|
|
HC DRAINAGE OF NASAL ABSCESS
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
4503000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$462.00
|
| Rate for Payer: AlohaCare Medicare |
$702.24
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$776.16
|
| 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 |
$702.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$702.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$702.24
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$702.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$702.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$702.24
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC DRAINAGE OF NASAL SEPTAL ABSCESS
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 30020
|
| Hospital Charge Code |
4503002001
|
|
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 DRAINAGE OF NASAL SEPTAL ABSCESS
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 30020
|
| Hospital Charge Code |
4503002001
|
|
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 DRAIN EXT EAR ABSC/BLOOD,COMPLIC
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
7616900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,900.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
7616900501
|
|
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 DRAIN FINGER ABSCESS,COMPLICATED
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
7612601101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,900.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRAIN FINGER ABSCESS,COMPLICATED
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
7612601101
|
|
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 DRAIN FINGER ABSCESS,SIMPLE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
7612601001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.86 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$256.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$403.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
