|
HC RESUPERF WND BODY <2.5CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
4501200101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC RESUPERF WND BODY <2.5CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
4501200101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC RESUPERF WND BODY >30 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
7611200701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC RESUPERF WND BODY >30 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
7611200701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC RESUPERF WND BODY 7.6-12.5 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
4501200401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC RESUPERF WND BODY 7.6-12.5 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
4501200401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC RESUPERF WND FACE <2.5 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
4501201101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC RESUPERF WND FACE <2.5 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
4501201101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC RESUPERF WND FACE 2.6-5 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
4501201301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC RESUPERF WND FACE 2.6-5 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
4501201301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC RESUP NPTERF WND BODY 2.6-7.5 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
4501200201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC RESUP NPTERF WND BODY 2.6-7.5 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
4501200201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
3058504501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
3058504501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$25.08
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$27.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.99
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$25.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.08
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.08
|
| Rate for Payer: University Health Alliance Commercial |
$10.34
|
|
|
HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR - RA QUANT
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
3028643101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
|
|
HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR - RA QUANT
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
3028643101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$36.48
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$40.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.67
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Humana Medicare |
$36.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.48
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.48
|
| Rate for Payer: University Health Alliance Commercial |
$14.67
|
|
|
HC ROOM DAILY
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
1200000004
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$1,564.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Devoted Health Medicare |
$1,720.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,140.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,564.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,140.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Humana Medicare |
$1,564.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,564.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,564.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,564.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HC RSV ID POCT
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
3068763402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$500.65 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.10
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
|
|
HC RSV ID POCT
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
3068763402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: AlohaCare Medicaid |
$294.50
|
| Rate for Payer: AlohaCare Medicare |
$447.64
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Devoted Health Medicare |
$494.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Humana Medicare |
$447.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.64
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$447.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.64
|
| Rate for Payer: University Health Alliance Commercial |
$160.32
|
|
|
HC RSVP AM PROBE
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
3068763401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$500.65 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.10
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
|
|
HC RSVP AM PROBE
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
3068763401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: AlohaCare Medicaid |
$294.50
|
| Rate for Payer: AlohaCare Medicare |
$447.64
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Devoted Health Medicare |
$494.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Humana Medicare |
$447.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.64
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$447.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.64
|
| Rate for Payer: University Health Alliance Commercial |
$160.32
|
|
|
HC RT CPAP NON-EMERGENT
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$784.73 |
| Rate for Payer: AlohaCare Medicaid |
$404.50
|
| Rate for Payer: AlohaCare Medicare |
$614.84
|
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Devoted Health Medicare |
$679.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$614.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$768.55
|
| Rate for Payer: Health Management Network Commercial |
$687.65
|
| Rate for Payer: Humana Medicare |
$614.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$412.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$614.84
|
| Rate for Payer: MDX Hawaii PPO |
$784.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$614.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$614.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$614.84
|
| Rate for Payer: University Health Alliance Commercial |
$589.68
|
|
|
HC RT CPAP NON-EMERGENT
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
4109466001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$687.65 |
| Max. Negotiated Rate |
$784.73 |
| Rate for Payer: Cash Price |
$485.40
|
| Rate for Payer: Health Management Network Commercial |
$687.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.10
|
| Rate for Payer: MDX Hawaii PPO |
$784.73
|
|
|
HC RT INHALATION TREATMENT
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$928.20 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Health Management Network Commercial |
$928.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$982.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,059.24
|
|
|
HC RT INHALATION TREATMENT
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: AlohaCare Medicaid |
$546.00
|
| Rate for Payer: AlohaCare Medicare |
$829.92
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Devoted Health Medicare |
$917.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$829.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,037.40
|
| Rate for Payer: Health Management Network Commercial |
$928.20
|
| Rate for Payer: Humana Medicare |
$829.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$556.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$829.92
|
| Rate for Payer: MDX Hawaii PPO |
$1,059.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$829.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$829.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$829.92
|
| Rate for Payer: University Health Alliance Commercial |
$795.96
|
|
