|
HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 97112 GO
|
| Hospital Charge Code |
4309711201
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 97167 GO
|
| Hospital Charge Code |
4349716701
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$107.85 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: AlohaCare Medicaid |
$245.00
|
| Rate for Payer: AlohaCare Medicare |
$372.40
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Devoted Health Medicare |
$411.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$465.50
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Humana Medicare |
$372.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$249.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.40
|
| Rate for Payer: MDX Hawaii PPO |
$475.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.40
|
| Rate for Payer: University Health Alliance Commercial |
$357.16
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 97167 GO
|
| Hospital Charge Code |
4349716701
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: MDX Hawaii PPO |
$475.30
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 97165 GO
|
| Hospital Charge Code |
4349716501
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$107.85 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: AlohaCare Medicaid |
$245.00
|
| Rate for Payer: AlohaCare Medicare |
$372.40
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Devoted Health Medicare |
$411.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$465.50
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Humana Medicare |
$372.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$249.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.40
|
| Rate for Payer: MDX Hawaii PPO |
$475.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.40
|
| Rate for Payer: University Health Alliance Commercial |
$357.16
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 97165 GO
|
| Hospital Charge Code |
4349716501
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: MDX Hawaii PPO |
$475.30
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
HCPCS 97166 GO
|
| Hospital Charge Code |
4349716601
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$107.85 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: AlohaCare Medicaid |
$245.00
|
| Rate for Payer: AlohaCare Medicare |
$372.40
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Devoted Health Medicare |
$411.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$465.50
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Humana Medicare |
$372.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$249.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.40
|
| Rate for Payer: MDX Hawaii PPO |
$475.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.40
|
| Rate for Payer: University Health Alliance Commercial |
$357.16
|
|
|
HC OT OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
HCPCS 97166 GO
|
| Hospital Charge Code |
4349716601
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$416.50 |
| Max. Negotiated Rate |
$475.30 |
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Health Management Network Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: MDX Hawaii PPO |
$475.30
|
|
|
HC OT OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 97168 GO
|
| Hospital Charge Code |
4349716801
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: AlohaCare Medicaid |
$171.00
|
| Rate for Payer: AlohaCare Medicare |
$259.92
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Devoted Health Medicare |
$287.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$259.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$324.90
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
| Rate for Payer: Humana Medicare |
$259.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$307.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$259.92
|
| Rate for Payer: MDX Hawaii PPO |
$331.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$259.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$259.92
|
| Rate for Payer: University Health Alliance Commercial |
$249.28
|
|
|
HC OT OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS 97168 GO
|
| Hospital Charge Code |
4349716801
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$307.80
|
| Rate for Payer: MDX Hawaii PPO |
$331.74
|
|
|
HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4309753501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
|
|
HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 97535 GO
|
| Hospital Charge Code |
4309753501
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: AlohaCare Medicaid |
$79.50
|
| Rate for Payer: AlohaCare Medicare |
$120.84
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$133.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$151.05
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Humana Medicare |
$120.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.84
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.84
|
| Rate for Payer: University Health Alliance Commercial |
$115.90
|
|
|
HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 97530 GO
|
| Hospital Charge Code |
4309753001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: AlohaCare Medicare |
$137.56
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Devoted Health Medicare |
$152.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.95
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Humana Medicare |
$137.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.56
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.56
|
| Rate for Payer: University Health Alliance Commercial |
$131.93
|
|
|
HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 97530 GO
|
| Hospital Charge Code |
4309753001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
HC OT THERAPEUTIC EXERCISES
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 97110 GO
|
| Hospital Charge Code |
4309711001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
HC OT THERAPEUTIC EXERCISES
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 97110 GO
|
| Hospital Charge Code |
4309711001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$106.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Devoted Health Medicare |
$117.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$133.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$106.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.40
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.40
|
| Rate for Payer: University Health Alliance Commercial |
$102.05
|
|
|
HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
3068717701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: AlohaCare Medicaid |
$37.50
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.90
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$23.00
|
|
|
HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 87177
|
| Hospital Charge Code |
3068717701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
|
|
HC OXYGEN HOURLY
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
2700000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
|
|
HC OXYGEN HOURLY
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
2700000026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: AlohaCare Medicaid |
$8.50
|
| Rate for Payer: AlohaCare Medicare |
$12.92
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Devoted Health Medicare |
$14.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.92
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.92
|
| Rate for Payer: University Health Alliance Commercial |
$12.39
|
|
|
HC PBB CLOSED RX CARPAL FX
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
76125630PB
|
|
Hospital Revenue Code
|
761
|
| 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 PBB CLOSED RX CARPAL FX
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
76125630PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.52 |
| Max. Negotiated Rate |
$906.95 |
| 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 Commercial |
$315.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$710.60
|
| 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 |
$476.85
|
| 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 |
$148.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC PBB CLOSED RX MANDIBLE FX+DENTAL FIX
|
Facility
|
IP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 21453
|
| Hospital Charge Code |
76121453PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,906.20 |
| Max. Negotiated Rate |
$5,598.84 |
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Health Management Network Commercial |
$4,906.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,194.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
|
|
HC PBB CLOSED RX MANDIBLE FX+DENTAL FIX
|
Facility
|
OP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 21453
|
| Hospital Charge Code |
76121453PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$7,560.06 |
| Rate for Payer: AlohaCare Medicaid |
$2,886.00
|
| Rate for Payer: AlohaCare Medicare |
$4,386.72
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Devoted Health Medicare |
$4,848.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,560.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,386.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,483.40
|
| Rate for Payer: Health Management Network Commercial |
$4,906.20
|
| Rate for Payer: Humana Medicare |
$4,386.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,194.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,943.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,386.72
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,386.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,386.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,386.72
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC PBB CLOSED RX NASAL SEPTAL FRACTURE
|
Facility
|
IP
|
$12,906.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
76121337PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,970.10 |
| Max. Negotiated Rate |
$12,518.82 |
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Health Management Network Commercial |
$10,970.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,615.40
|
| Rate for Payer: MDX Hawaii PPO |
$12,518.82
|
|
|
HC PBB CLOSED RX NASAL SEPTAL FRACTURE
|
Facility
|
OP
|
$12,906.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
76121337PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$12,518.82 |
| Rate for Payer: AlohaCare Medicaid |
$6,453.00
|
| Rate for Payer: AlohaCare Medicare |
$9,808.56
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Cash Price |
$7,743.60
|
| Rate for Payer: Devoted Health Medicare |
$10,841.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,234.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,808.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,260.70
|
| Rate for Payer: Health Management Network Commercial |
$10,970.10
|
| Rate for Payer: Humana Medicare |
$9,808.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,615.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,582.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,808.56
|
| Rate for Payer: MDX Hawaii PPO |
$12,518.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,808.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,808.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,808.56
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
