|
HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
3207205201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADEX SPINE CERVICAL 6 OR MORE VIEWS - XR C-SPINE COMPLETE 6+ VIEWS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
3207205201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$132.40
|
|
|
HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
3207208001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADEX X-RAY EXAM THORACOLMB 2+ VW - XR THORACOLUMBAR SPINE 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 72080
|
| Hospital Charge Code |
3207208001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$72.83
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
3207401802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 1 VIEW - XR ABDOMEN 1 VIEW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
3207401802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS - XR ABDOMEN 2 VW POSTER W DECUBITUS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
3207401901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
3247104601
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$67.43
|
|
|
HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
3058565101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
3058565101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$27.36
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$30.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$27.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.36
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.36
|
| Rate for Payer: University Health Alliance Commercial |
$9.18
|
|
|
HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
4501313101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$1,208.40
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$1,335.60
|
| 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 |
$1,208.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$1,208.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,208.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,208.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,208.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,208.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
4501313101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC RECMPL WND LID,NOS,EAR 2.5-7.5 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
4501315201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC RECMPL WND LID,NOS,EAR 2.5-7.5 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13152
|
| Hospital Charge Code |
4501315201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,218.00
|
| Rate for Payer: AlohaCare Medicare |
$1,851.36
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$2,046.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,851.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$1,851.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,851.36
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,851.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,851.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,851.36
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
4501312101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
4501312101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,218.00
|
| Rate for Payer: AlohaCare Medicare |
$1,851.36
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$2,046.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,851.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$1,851.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,851.36
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,851.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,851.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,851.36
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC RECONSTRUC OF NAIL BED
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4501176001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,218.00
|
| Rate for Payer: AlohaCare Medicare |
$1,851.36
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$2,046.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,851.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$1,851.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,851.36
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,851.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,851.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,851.36
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC RECONSTRUC OF NAIL BED
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
4501176001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7616921001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$179.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$198.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$179.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.36
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
