|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, FOREARM AND/OR WRIST
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
4502502801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,524.64 |
| Rate for Payer: AlohaCare Medicaid |
$6,456.00
|
| Rate for Payer: AlohaCare Medicare |
$9,813.12
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Devoted Health Medicare |
$10,846.08
|
| 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 |
$9,813.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,266.40
|
| Rate for Payer: Health Management Network Commercial |
$10,975.20
|
| Rate for Payer: Humana Medicare |
$9,813.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,620.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,813.12
|
| Rate for Payer: MDX Hawaii PPO |
$12,524.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,813.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,813.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,813.12
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, FOREARM AND/OR WRIST
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
4502502801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,975.20 |
| Max. Negotiated Rate |
$12,524.64 |
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Health Management Network Commercial |
$10,975.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,620.80
|
| Rate for Payer: MDX Hawaii PPO |
$12,524.64
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SHOULDER AREA
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
4502303001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,681.50 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,251.00
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SHOULDER AREA
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
4502303001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: AlohaCare Medicaid |
$5,695.00
|
| Rate for Payer: AlohaCare Medicare |
$8,656.40
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Devoted Health Medicare |
$9,567.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,656.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,820.50
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Humana Medicare |
$8,656.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,251.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,656.40
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,656.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,656.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,656.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INCISION AND DRAINAGE, INFECTED BURSA, FOREARM AND/OR WRIST
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
4502503101
|
|
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 INCISION AND DRAINAGE, INFECTED BURSA, FOREARM AND/OR WRIST
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
4502503101
|
|
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 |
$5,160.40
|
|
|
HC INCISION AND DRAINAGE OF RECTAL ABSCESS
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
4504500501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,988.20 |
| Max. Negotiated Rate |
$4,551.24 |
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,222.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
|
|
HC INCISION AND DRAINAGE OF RECTAL ABSCESS
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
4504500501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,346.00
|
| Rate for Payer: AlohaCare Medicare |
$3,565.92
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Devoted Health Medicare |
$3,941.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,565.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,457.40
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Humana Medicare |
$3,565.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,222.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,565.92
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,565.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,565.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,565.92
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
4502393001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,480.05 |
| Max. Negotiated Rate |
$10,818.41 |
| Rate for Payer: Cash Price |
$6,691.80
|
| Rate for Payer: Health Management Network Commercial |
$9,480.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,037.70
|
| Rate for Payer: MDX Hawaii PPO |
$10,818.41
|
|
|
HC INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
4502393001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,818.41 |
| Rate for Payer: AlohaCare Medicaid |
$5,576.50
|
| Rate for Payer: AlohaCare Medicare |
$8,476.28
|
| Rate for Payer: Cash Price |
$6,691.80
|
| Rate for Payer: Cash Price |
$6,691.80
|
| Rate for Payer: Devoted Health Medicare |
$9,368.52
|
| 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 |
$8,476.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,595.35
|
| Rate for Payer: Health Management Network Commercial |
$9,480.05
|
| Rate for Payer: Humana Medicare |
$8,476.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,037.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,476.28
|
| Rate for Payer: MDX Hawaii PPO |
$10,818.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,476.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,476.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,476.28
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INF DIS BACT VAGINOSIS QT
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 81513
|
| Hospital Charge Code |
3008151301
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$1,161.09 |
| 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 |
$174.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$178.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$909.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$177.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.63
|
| 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 |
$610.47
|
| 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 Medicaid |
$106.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$909.72
|
| Rate for Payer: University Health Alliance Commercial |
$872.49
|
|
|
HC INF DIS BACT VAGINOSIS QT
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 81513
|
| Hospital Charge Code |
3008151301
|
|
Hospital Revenue Code
|
300
|
| 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 INFLUENZA A&B RT AMP PROBE
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
|
|
HC INFLUENZA A&B RT AMP PROBE
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: AlohaCare Medicaid |
$402.00
|
| Rate for Payer: AlohaCare Medicare |
$611.04
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Devoted Health Medicare |
$675.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$611.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Humana Medicare |
$611.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$611.04
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$611.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$611.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$611.04
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
HC INFLUENZA ID POCT
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
|
|
HC INFLUENZA ID POCT
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: AlohaCare Medicaid |
$402.00
|
| Rate for Payer: AlohaCare Medicare |
$611.04
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Devoted Health Medicare |
$675.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$611.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Humana Medicare |
$611.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$611.04
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$611.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$611.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$611.04
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
HC INITIAL RX BURN(S) 1ST DEGREE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
7611600001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC INITIAL RX BURN(S) 1ST DEGREE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
7611600001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC INJ,ANES AGENT,BRACHIAL PLEXUS,SINGLE
|
Facility
|
IP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
3616441501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,011.55 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,188.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
|
|
HC INJ,ANES AGENT,BRACHIAL PLEXUS,SINGLE
|
Facility
|
OP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
3616441501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: UnitedHealthcare Medicare |
$2,692.68
|
| Rate for Payer: AlohaCare Medicaid |
$1,771.50
|
| Rate for Payer: AlohaCare Medicare |
$2,692.68
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Devoted Health Medicare |
$2,976.12
|
| 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 |
$2,692.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,365.85
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: Humana Medicare |
$2,692.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,188.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,692.68
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,692.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,692.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: University Health Alliance Commercial |
$2,582.49
|
|
|
HC INJ,ANES AGENT,FEMORAL NERVE,SINGLE
|
Facility
|
OP
|
$2,756.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
3706444701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,378.00
|
| Rate for Payer: AlohaCare Medicare |
$2,094.56
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Devoted Health Medicare |
$2,315.04
|
| 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 |
$2,094.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,618.20
|
| Rate for Payer: Health Management Network Commercial |
$2,342.60
|
| Rate for Payer: Humana Medicare |
$2,094.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,480.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,094.56
|
| Rate for Payer: MDX Hawaii PPO |
$2,673.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,094.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,094.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,094.56
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INJ,ANES AGENT,FEMORAL NERVE,SINGLE
|
Facility
|
IP
|
$2,756.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
3706444701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,342.60 |
| Max. Negotiated Rate |
$2,673.32 |
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Health Management Network Commercial |
$2,342.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,480.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,673.32
|
|
|
HC INJ,ANES AGENT,SCIATIC NERVE,SINGLE
|
Facility
|
OP
|
$2,699.00
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
3706444501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,618.03 |
| Rate for Payer: AlohaCare Medicaid |
$1,349.50
|
| Rate for Payer: AlohaCare Medicare |
$2,051.24
|
| Rate for Payer: Cash Price |
$1,619.40
|
| Rate for Payer: Cash Price |
$1,619.40
|
| Rate for Payer: Devoted Health Medicare |
$2,267.16
|
| 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 |
$2,051.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,564.05
|
| Rate for Payer: Health Management Network Commercial |
$2,294.15
|
| Rate for Payer: Humana Medicare |
$2,051.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,429.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,051.24
|
| Rate for Payer: MDX Hawaii PPO |
$2,618.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,051.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,051.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,051.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,967.30
|
|
|
HC INJ,ANES AGENT,SCIATIC NERVE,SINGLE
|
Facility
|
IP
|
$2,699.00
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
3706444501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,294.15 |
| Max. Negotiated Rate |
$2,618.03 |
| Rate for Payer: Cash Price |
$1,619.40
|
| Rate for Payer: Health Management Network Commercial |
$2,294.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,429.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,618.03
|
|
|
HC INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL
|
Facility
|
OP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
3616449001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,771.50
|
| Rate for Payer: AlohaCare Medicare |
$2,692.68
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Devoted Health Medicare |
$2,976.12
|
| 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 |
$2,692.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,365.85
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: Humana Medicare |
$2,692.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,188.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,692.68
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,692.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,692.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,692.68
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
