|
HC SUTURE EYELID WOUND,FULL THICK
|
Facility
|
IP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67935
|
| Hospital Charge Code |
3616793501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,727.35 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
|
|
HC SUTURE EYELID WOUND,FULL THICK
|
Facility
|
OP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67935
|
| Hospital Charge Code |
3616793501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: AlohaCare Medicaid |
$4,545.50
|
| Rate for Payer: AlohaCare Medicare |
$6,909.16
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Devoted Health Medicare |
$7,636.44
|
| 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 |
$6,909.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,636.45
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Humana Medicare |
$6,909.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,909.16
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,909.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,909.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,909.16
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC SUTURE EYELID WOUND,PARTIAL THICK
|
Facility
|
OP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
3616793001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: AlohaCare Medicaid |
$4,545.50
|
| Rate for Payer: AlohaCare Medicare |
$6,909.16
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Devoted Health Medicare |
$7,636.44
|
| 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 |
$6,909.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,636.45
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Humana Medicare |
$6,909.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,909.16
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,909.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,909.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,909.16
|
| Rate for Payer: University Health Alliance Commercial |
$6,626.43
|
|
|
HC SUTURE EYELID WOUND,PARTIAL THICK
|
Facility
|
IP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
3616793001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,727.35 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| 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 SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| 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 |
$5.90
|
| 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 |
$6.20
|
| 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 |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.36
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST - QUANTIFERON TB GOLD TUBE
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
3028648001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.95 |
| Max. Negotiated Rate |
$504.40 |
| Rate for Payer: AlohaCare Medicaid |
$260.00
|
| Rate for Payer: AlohaCare Medicare |
$395.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$436.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.98
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Humana Medicare |
$395.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$265.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$395.20
|
| Rate for Payer: MDX Hawaii PPO |
$504.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.20
|
| Rate for Payer: University Health Alliance Commercial |
$160.19
|
|
|
HC TB TEST, CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON - TB TEST - QUANTIFERON TB GOLD TUBE
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
3028648001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$504.40 |
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.00
|
| Rate for Payer: MDX Hawaii PPO |
$504.40
|
|
|
HC TEMPORARY EXTERNAL PACING
|
Facility
|
OP
|
$2,604.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
4819295301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,525.88 |
| Rate for Payer: AlohaCare Medicaid |
$1,302.00
|
| Rate for Payer: AlohaCare Medicare |
$1,979.04
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Devoted Health Medicare |
$2,187.36
|
| 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 |
$1,979.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,473.80
|
| Rate for Payer: Health Management Network Commercial |
$2,213.40
|
| Rate for Payer: Humana Medicare |
$1,979.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,343.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,979.04
|
| Rate for Payer: MDX Hawaii PPO |
$2,525.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,979.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,979.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,979.04
|
| Rate for Payer: University Health Alliance Commercial |
$1,898.06
|
|
|
HC TEMPORARY EXTERNAL PACING
|
Facility
|
IP
|
$2,604.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
4819295301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,213.40 |
| Max. Negotiated Rate |
$2,525.88 |
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Health Management Network Commercial |
$2,213.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,343.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,525.88
|
|
|
HC THER IVNTJ 1ST 15 MIN
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
4309712901
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
|
|
HC THER IVNTJ 1ST 15 MIN
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
4309712901
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: AlohaCare Medicaid |
$51.50
|
| Rate for Payer: AlohaCare Medicare |
$78.28
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$86.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.85
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Humana Medicare |
$78.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.28
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.28
|
| Rate for Payer: University Health Alliance Commercial |
$75.08
|
|
|
HC THROMBOPLAS TIME PARTIAL - PTT
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
3058573002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.00
|
| Rate for Payer: MDX Hawaii PPO |
$48.50
|
|
|
HC THROMBOPLAS TIME PARTIAL - PTT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
3058573002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: AlohaCare Medicaid |
$25.00
|
| Rate for Payer: AlohaCare Medicare |
$38.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Devoted Health Medicare |
$42.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Humana Medicare |
$38.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.00
|
| Rate for Payer: MDX Hawaii PPO |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.00
|
| Rate for Payer: University Health Alliance Commercial |
$15.50
|
|
|
HC TOE(S) MIN 2V BILAT
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.91 |
| 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 |
$13.91
|
| 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 |
$14.94
|
| 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 |
$13.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$53.35
|
|
|
HC TOE(S) MIN 2V BILAT
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
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 TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
4027681701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.06 |
| 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 |
$46.06
|
| 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 |
$53.86
|
| 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 |
$46.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$193.75
|
|
|
HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
4027681701
|
|
Hospital Revenue Code
|
402
|
| 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 TREAT THUMB FX/DISLOC,MANIP
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
7612664501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,300.60 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
|
|
HC TREAT THUMB FX/DISLOC,MANIP
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
7612664501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: AlohaCare Medicaid |
$3,118.00
|
| Rate for Payer: AlohaCare Medicare |
$4,739.36
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Devoted Health Medicare |
$5,238.24
|
| 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 |
$4,739.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,924.20
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Humana Medicare |
$4,739.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,739.36
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,739.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,739.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,739.36
|
| Rate for Payer: University Health Alliance Commercial |
$4,545.42
|
|
|
HC TRICH VAGINALIS AMP PROBE
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
3068766101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC TRICH VAGINALIS AMP PROBE
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
3068766101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$223.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$246.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$223.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$223.44
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$88.56
|
|
|
HC TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4501171901
|
|
Hospital Revenue Code
|
450
|
| 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 TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4501171901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$179.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC TTE W/DOPPLER COMPLETE - TTE COMPLETE
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
4839330602
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$132.88 |
| Max. Negotiated Rate |
$3,812.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,965.00
|
| Rate for Payer: AlohaCare Medicare |
$2,986.80
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Devoted Health Medicare |
$3,301.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,986.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$191.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,733.50
|
| Rate for Payer: Health Management Network Commercial |
$3,340.50
|
| Rate for Payer: Humana Medicare |
$2,986.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,537.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,004.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,986.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,812.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,986.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,986.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,986.80
|
| Rate for Payer: University Health Alliance Commercial |
$2,864.58
|
|
