|
HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7616921001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
7616920901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.16 |
| Max. Negotiated Rate |
$228.92 |
| 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: 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 |
$18.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
7616920901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
4506793801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$595.00
|
| Rate for Payer: AlohaCare Medicare |
$904.40
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Devoted Health Medicare |
$999.60
|
| 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 |
$904.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,130.50
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$904.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$904.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$904.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$904.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$904.40
|
| Rate for Payer: University Health Alliance Commercial |
$867.39
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
4506793801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
|
Facility
|
OP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 41805
|
| Hospital Charge Code |
4504180501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,598.84 |
| 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: Devoted Health Medicare |
$4,848.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,386.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,386.72
|
| Rate for Payer: University Health Alliance Commercial |
$4,207.21
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
|
Facility
|
IP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 41805
|
| Hospital Charge Code |
4504180501
|
|
Hospital Revenue Code
|
450
|
| 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 REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
4504080501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,686.40 |
| Max. Negotiated Rate |
$1,924.48 |
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
4504080501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| 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 ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,507.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,884.80
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Humana Medicare |
$1,507.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,507.84
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,507.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,507.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,507.84
|
| Rate for Payer: University Health Alliance Commercial |
$1,446.14
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
4504080401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: AlohaCare Medicaid |
$1,865.50
|
| Rate for Payer: AlohaCare Medicare |
$2,835.56
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Devoted Health Medicare |
$3,134.04
|
| 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 |
$2,835.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,544.45
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: Humana Medicare |
$2,835.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,357.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,835.56
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,835.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,835.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,835.56
|
| Rate for Payer: University Health Alliance Commercial |
$2,719.53
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
4504080401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,171.35 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,357.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
|
|
HC REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4504591501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,551.24 |
| 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 |
$3,420.00
|
|
|
HC REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4504591501
|
|
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 REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
7612052001
|
|
Hospital Revenue Code
|
450
|
| 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: Devoted Health Medicare |
$5,416.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,900.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,125.60
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$4,900.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,900.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,900.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,900.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,900.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,699.95
|
|
|
HC REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
7612052001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC REMOVAL OF FOREIGN BODY FROM SCROTUM
|
Facility
|
OP
|
$7,982.00
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
4505512001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,742.54 |
| Rate for Payer: AlohaCare Medicaid |
$3,991.00
|
| Rate for Payer: AlohaCare Medicare |
$6,066.32
|
| Rate for Payer: Cash Price |
$4,789.20
|
| Rate for Payer: Cash Price |
$4,789.20
|
| Rate for Payer: Devoted Health Medicare |
$6,704.88
|
| 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 |
$6,066.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,582.90
|
| Rate for Payer: Health Management Network Commercial |
$6,784.70
|
| Rate for Payer: Humana Medicare |
$6,066.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,183.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,066.32
|
| Rate for Payer: MDX Hawaii PPO |
$7,742.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,066.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,066.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,066.32
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC REMOVAL OF FOREIGN BODY FROM SCROTUM
|
Facility
|
IP
|
$7,982.00
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
4505512001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,784.70 |
| Max. Negotiated Rate |
$7,742.54 |
| Rate for Payer: Cash Price |
$4,789.20
|
| Rate for Payer: Health Management Network Commercial |
$6,784.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,183.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,742.54
|
|
|
HC REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
4502052501
|
|
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 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
4502052501
|
|
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 |
$6,743.44
|
|
|
HC REMOVAL OF FOREIGN BODY, PELVIS OR HIP JOINT AREA; DEEP
|
Facility
|
IP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
4502708701
|
|
Hospital Revenue Code
|
450
|
| 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 REMOVAL OF FOREIGN BODY, PELVIS OR HIP JOINT AREA; DEEP
|
Facility
|
OP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
4502708701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| 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: Devoted Health Medicare |
$10,620.12
|
| 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 |
$9,608.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 |
$6,743.44
|
|
|
HC REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBQ TISSUE
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 27086
|
| Hospital Charge Code |
4502708601
|
|
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 REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBQ TISSUE
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 27086
|
| Hospital Charge Code |
4502708601
|
|
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 REMOVAL OF FOREIGN BODY, SHOULDER; DEEP
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
4502333301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,476.28
|
| Rate for Payer: University Health Alliance Commercial |
$8,129.42
|
|
|
HC REMOVAL OF FOREIGN BODY, SHOULDER; DEEP
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
4502333301
|
|
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
|
|
