|
HC RT NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4609476001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: AlohaCare Medicaid |
$39.50
|
| Rate for Payer: AlohaCare Medicare |
$60.04
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Devoted Health Medicare |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$75.05
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Humana Medicare |
$60.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.04
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.04
|
| Rate for Payer: University Health Alliance Commercial |
$57.58
|
|
|
HC RT NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
4609476001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
|
|
HC SARSCOVID19 RAPID ANTIGEN POCT
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
3068781101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$336.59 |
| Rate for Payer: AlohaCare Medicaid |
$173.50
|
| Rate for Payer: AlohaCare Medicare |
$263.72
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Devoted Health Medicare |
$291.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$263.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.38
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Humana Medicare |
$263.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$263.72
|
| Rate for Payer: MDX Hawaii PPO |
$336.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$263.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$263.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$263.72
|
| Rate for Payer: University Health Alliance Commercial |
$252.93
|
|
|
HC SARSCOVID19 RAPID ANTIGEN POCT
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
3068781101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$294.95 |
| Max. Negotiated Rate |
$336.59 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.30
|
| Rate for Payer: MDX Hawaii PPO |
$336.59
|
|
|
HC SENSITIVITY PER ENZYME
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3068718501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$33.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.40
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.40
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
HC SENSITIVITY PER ENZYME
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3068718501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY - ENDOSCOPY SIGMOID
|
Facility
|
IP
|
$4,595.00
|
|
|
Service Code
|
HCPCS 45332
|
| Hospital Charge Code |
7504533201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,905.75 |
| Max. Negotiated Rate |
$4,457.15 |
| Rate for Payer: Cash Price |
$2,757.00
|
| Rate for Payer: Health Management Network Commercial |
$3,905.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,135.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,457.15
|
|
|
HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY - ENDOSCOPY SIGMOID
|
Facility
|
OP
|
$4,595.00
|
|
|
Service Code
|
HCPCS 45332
|
| Hospital Charge Code |
7504533201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,457.15 |
| Rate for Payer: AlohaCare Medicaid |
$2,297.50
|
| Rate for Payer: AlohaCare Medicare |
$3,492.20
|
| Rate for Payer: Cash Price |
$2,757.00
|
| Rate for Payer: Cash Price |
$2,757.00
|
| Rate for Payer: Devoted Health Medicare |
$3,859.80
|
| 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 |
$3,492.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,365.25
|
| Rate for Payer: Health Management Network Commercial |
$3,905.75
|
| Rate for Payer: Humana Medicare |
$3,492.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,135.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,492.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,457.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,492.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,492.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,492.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,349.30
|
|
|
HC SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
4501201701
|
|
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
4501201701
|
|
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
4501201801
|
|
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
4501201801
|
|
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 SLP ASSESSMENT OF APHASIA
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
4449610501
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
HC SLP ASSESSMENT OF APHASIA
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
4449610501
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: AlohaCare Medicaid |
$227.00
|
| Rate for Payer: AlohaCare Medicare |
$345.04
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Devoted Health Medicare |
$381.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$345.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$431.30
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$345.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.04
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$345.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$345.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$345.04
|
| Rate for Payer: University Health Alliance Commercial |
$330.92
|
|
|
HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 92524
|
| Hospital Charge Code |
4449252401
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$443.70 |
| Max. Negotiated Rate |
$506.34 |
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.80
|
| Rate for Payer: MDX Hawaii PPO |
$506.34
|
|
|
HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 92524
|
| Hospital Charge Code |
4449252401
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$506.34 |
| Rate for Payer: AlohaCare Medicaid |
$261.00
|
| Rate for Payer: AlohaCare Medicare |
$396.72
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Devoted Health Medicare |
$438.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$396.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.90
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Humana Medicare |
$396.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.72
|
| Rate for Payer: MDX Hawaii PPO |
$506.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$396.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$396.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$396.72
|
| Rate for Payer: University Health Alliance Commercial |
$380.49
|
|
|
HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 92610 GN
|
| Hospital Charge Code |
4449261001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$88.36 |
| Max. Negotiated Rate |
$318.16 |
| Rate for Payer: AlohaCare Medicaid |
$164.00
|
| Rate for Payer: AlohaCare Medicare |
$249.28
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Devoted Health Medicare |
$275.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$311.60
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: Humana Medicare |
$249.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$249.28
|
| Rate for Payer: MDX Hawaii PPO |
$318.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$249.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.28
|
| Rate for Payer: University Health Alliance Commercial |
$239.08
|
|
|
HC SLP EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 92610 GN
|
| Hospital Charge Code |
4449261001
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$318.16 |
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.20
|
| Rate for Payer: MDX Hawaii PPO |
$318.16
|
|
|
HC SLP EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
HCPCS 92521
|
| Hospital Charge Code |
4449252101
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$543.15 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Health Management Network Commercial |
$543.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$575.10
|
| Rate for Payer: MDX Hawaii PPO |
$619.83
|
|
|
HC SLP EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
HCPCS 92521
|
| Hospital Charge Code |
4449252101
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$619.83 |
| Rate for Payer: AlohaCare Medicaid |
$319.50
|
| Rate for Payer: AlohaCare Medicare |
$485.64
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Devoted Health Medicare |
$536.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$485.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$607.05
|
| Rate for Payer: Health Management Network Commercial |
$543.15
|
| Rate for Payer: Humana Medicare |
$485.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$575.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$325.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$485.64
|
| Rate for Payer: MDX Hawaii PPO |
$619.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$485.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$485.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$485.64
|
| Rate for Payer: University Health Alliance Commercial |
$465.77
|
|
|
HC SLP SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 97533
|
| Hospital Charge Code |
4409753301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$219.22 |
| Rate for Payer: AlohaCare Medicaid |
$113.00
|
| Rate for Payer: AlohaCare Medicare |
$171.76
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Devoted Health Medicare |
$189.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.70
|
| Rate for Payer: Health Management Network Commercial |
$192.10
|
| Rate for Payer: Humana Medicare |
$171.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.76
|
| Rate for Payer: MDX Hawaii PPO |
$219.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.76
|
| Rate for Payer: University Health Alliance Commercial |
$164.73
|
|
|
HC SLP SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 97533
|
| Hospital Charge Code |
4409753301
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$192.10 |
| Max. Negotiated Rate |
$219.22 |
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Health Management Network Commercial |
$192.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$203.40
|
| Rate for Payer: MDX Hawaii PPO |
$219.22
|
|
|
HC SMEAR COMPLEX W/INTERP O&P
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
3068720901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: AlohaCare Medicaid |
$75.50
|
| Rate for Payer: AlohaCare Medicare |
$114.76
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Devoted Health Medicare |
$126.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.98
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Humana Medicare |
$114.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.76
|
| Rate for Payer: MDX Hawaii PPO |
$146.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.76
|
| Rate for Payer: University Health Alliance Commercial |
$46.45
|
|
|
HC SMEAR COMPLEX W/INTERP O&P
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
3068720901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.90
|
| Rate for Payer: MDX Hawaii PPO |
$146.47
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685703
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| 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 |
$44.29
|
| 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 |
$69.53
|
| 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 |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
