|
HC PBB POSTOP FOLLOW-UP VISIT TC
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 99024
|
| Hospital Charge Code |
51099024PB
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$389.88
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$430.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.88
|
| 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 |
$261.63
|
| 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 PBB REFOREARM TEND/MUSC,EXTEN,PRIM,EA
|
Facility
|
IP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76125270PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,746.55 |
| Max. Negotiated Rate |
$12,263.71 |
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Health Management Network Commercial |
$10,746.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,378.70
|
| Rate for Payer: MDX Hawaii PPO |
$12,263.71
|
|
|
HC PBB REFOREARM TEND/MUSC,EXTEN,PRIM,EA
|
Facility
|
OP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 25270
|
| Hospital Charge Code |
76125270PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$12,263.71 |
| Rate for Payer: AlohaCare Medicaid |
$6,321.50
|
| Rate for Payer: AlohaCare Medicare |
$9,608.68
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Devoted Health Medicare |
$10,620.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,178.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,608.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,010.85
|
| Rate for Payer: Health Management Network Commercial |
$10,746.55
|
| Rate for Payer: Humana Medicare |
$9,608.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,378.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,447.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,608.68
|
| Rate for Payer: MDX Hawaii PPO |
$12,263.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,608.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,608.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,608.68
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
HC PBB REFOREARM TEND/MUSC,FLEX,PRIM,EA
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
76125260PB
|
|
Hospital Revenue Code
|
761
|
| 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 PBB REFOREARM TEND/MUSC,FLEX,PRIM,EA
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25260
|
| Hospital Charge Code |
76125260PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| 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: Cash Price |
$7,747.20
|
| Rate for Payer: Devoted Health Medicare |
$10,846.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,178.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,813.12
|
| 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 |
$6,585.12
|
| 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 |
$10,679.55
|
|
|
HC PBB REMOVE FOREARM/WRIST FOREIGN BODY
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76125248PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,053.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,840.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,050.55
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Humana Medicare |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,248.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC PBB REMOVE FOREARM/WRIST FOREIGN BODY
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76125248PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,413.65 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC PBB REMV FOOT FOREIGN BODY,COMPLEX
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76128193PB
|
|
Hospital Revenue Code
|
761
|
| 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: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$5,416.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,109.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,900.48
|
| 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 |
$3,288.48
|
| 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 PBB REMV FOOT FOREIGN BODY,COMPLEX
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76128193PB
|
|
Hospital Revenue Code
|
761
|
| 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 PBB REMV FOOT FOREIGN BODY,DEEP
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76128192PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| 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: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$5,416.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,109.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,900.48
|
| 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 |
$3,288.48
|
| 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 |
$5,160.40
|
|
|
HC PBB REMV FOOT FOREIGN BODY,DEEP
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76128192PB
|
|
Hospital Revenue Code
|
761
|
| 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 PBB REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76126418PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,413.65 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC PBB REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
76126418PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$4,840.44
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$5,349.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,053.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,840.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,050.55
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Humana Medicare |
$4,840.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,248.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,840.44
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,840.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,840.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,840.44
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
HC PBB REPAIR PALATE LACER <2 CM
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 42180
|
| Hospital Charge Code |
76142180PB
|
|
Hospital Revenue Code
|
761
|
| 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 PBB REPAIR PALATE LACER <2 CM
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 42180
|
| Hospital Charge Code |
76142180PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.66 |
| Max. Negotiated Rate |
$1,924.48 |
| 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 Commercial |
$688.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,507.84
|
| 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 |
$1,011.84
|
| 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 Medicaid |
$137.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,507.84
|
| Rate for Payer: University Health Alliance Commercial |
$1,446.14
|
|
|
HC P-INC DRAIN ABSC HEMATOMA
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
3612699001
|
|
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 P-INC DRAIN ABSC HEMATOMA
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
3612699001
|
|
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 PRETREAT SERUM BY DILUT SO
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 86976
|
| Hospital Charge Code |
3008697601
|
|
Hospital Revenue Code
|
300
|
| 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 PRETREAT SERUM BY DILUT SO
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 86976
|
| Hospital Charge Code |
3008697601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| 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 Commercial |
$36.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.55
|
| 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 |
$18.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.68
|
| Rate for Payer: University Health Alliance Commercial |
$177.12
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
3018414501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: AlohaCare Medicaid |
$114.00
|
| Rate for Payer: AlohaCare Medicare |
$173.28
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Devoted Health Medicare |
$191.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Humana Medicare |
$173.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.28
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.28
|
| Rate for Payer: University Health Alliance Commercial |
$51.36
|
|
|
HC PROCALCITONIN
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
3018414501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
|
HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID
|
Facility
|
OP
|
$10,686.00
|
|
|
Service Code
|
HCPCS 45307
|
| Hospital Charge Code |
7504530701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,365.42 |
| Rate for Payer: AlohaCare Medicaid |
$5,343.00
|
| Rate for Payer: AlohaCare Medicare |
$8,121.36
|
| Rate for Payer: Cash Price |
$6,411.60
|
| Rate for Payer: Cash Price |
$6,411.60
|
| Rate for Payer: Devoted Health Medicare |
$8,976.24
|
| 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 |
$8,121.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,151.70
|
| Rate for Payer: Health Management Network Commercial |
$9,083.10
|
| Rate for Payer: Humana Medicare |
$8,121.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,617.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,121.36
|
| Rate for Payer: MDX Hawaii PPO |
$10,365.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,121.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,121.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,121.36
|
| Rate for Payer: University Health Alliance Commercial |
$7,789.03
|
|
|
HC PROCTOSIGMOIDOSCOPY,REMV F.B. - ENDOSCOPY SIGMOID
|
Facility
|
IP
|
$10,686.00
|
|
|
Service Code
|
HCPCS 45307
|
| Hospital Charge Code |
7504530701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,083.10 |
| Max. Negotiated Rate |
$10,365.42 |
| Rate for Payer: Cash Price |
$6,411.60
|
| Rate for Payer: Health Management Network Commercial |
$9,083.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,617.40
|
| Rate for Payer: MDX Hawaii PPO |
$10,365.42
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3018416501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$68.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$75.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$68.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.40
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3018416501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
