|
PERSONA FEM PS POR NRW SZ9 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR NRW SZ9 R
|
Facility
|
OP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,987.00 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ10 L
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ10 L
|
Facility
|
OP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,987.00 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ10 R
|
Facility
|
OP
|
$7,400.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,700.00 |
| Max. Negotiated Rate |
$7,178.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,700.00
|
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$5,624.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Devoted Health Medicare |
$6,216.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,624.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$5,624.00
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,774.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,624.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,624.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,624.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,624.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ10 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ11 L
|
Facility
|
OP
|
$7,400.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,700.00 |
| Max. Negotiated Rate |
$7,178.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,700.00
|
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$5,624.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Devoted Health Medicare |
$6,216.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,624.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$5,624.00
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,774.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,624.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,624.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,624.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,624.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ11 L
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ11 R
|
Facility
|
OP
|
$9,310.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,655.00 |
| Max. Negotiated Rate |
$9,030.70 |
| Rate for Payer: AlohaCare Medicaid |
$4,655.00
|
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$7,075.60
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Devoted Health Medicare |
$7,820.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,075.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,517.00
|
| Rate for Payer: Health Management Network Commercial |
$7,913.50
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$7,075.60
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,748.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,075.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: MDX Hawaii PPO |
$9,030.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,075.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,075.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,075.60
|
| Rate for Payer: University Health Alliance Commercial |
$5,213.60
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ11 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,517.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$7,913.50
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$9,030.70
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$5,213.60
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ12 L
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,517.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$7,913.50
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$9,030.70
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$5,213.60
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ12 L
|
Facility
|
OP
|
$9,310.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,655.00 |
| Max. Negotiated Rate |
$9,030.70 |
| Rate for Payer: AlohaCare Medicaid |
$4,655.00
|
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$7,075.60
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Devoted Health Medicare |
$7,820.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,075.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,517.00
|
| Rate for Payer: Health Management Network Commercial |
$7,913.50
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$7,075.60
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,748.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,075.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: MDX Hawaii PPO |
$9,030.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,075.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,075.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,075.60
|
| Rate for Payer: University Health Alliance Commercial |
$5,213.60
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ12 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ12 R
|
Facility
|
OP
|
$7,400.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,700.00 |
| Max. Negotiated Rate |
$7,178.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,700.00
|
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$5,624.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Devoted Health Medicare |
$6,216.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,624.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$5,624.00
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,774.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,624.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,624.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,624.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,624.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ3 L
|
Facility
|
OP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,987.00 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ3 L
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ3 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ3 R
|
Facility
|
OP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,987.00 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ4 L
|
Facility
|
OP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,987.00 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ4 L
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ4 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ4 R
|
Facility
|
OP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,987.00 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ5 L
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,517.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$7,913.50
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$9,030.70
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$5,213.60
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ5 L
|
Facility
|
OP
|
$9,310.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,655.00 |
| Max. Negotiated Rate |
$9,030.70 |
| Rate for Payer: AlohaCare Medicaid |
$4,655.00
|
| Rate for Payer: AlohaCare Medicaid |
$9,987.00
|
| Rate for Payer: AlohaCare Medicare |
$7,075.60
|
| Rate for Payer: AlohaCare Medicare |
$15,180.24
|
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$5,586.00
|
| Rate for Payer: Devoted Health Medicare |
$16,778.16
|
| Rate for Payer: Devoted Health Medicare |
$7,820.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,180.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,075.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,517.00
|
| Rate for Payer: Health Management Network Commercial |
$7,913.50
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Humana Medicare |
$7,075.60
|
| Rate for Payer: Humana Medicare |
$15,180.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,379.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10,186.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,748.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,075.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,180.24
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: MDX Hawaii PPO |
$9,030.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,075.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,180.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,075.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,180.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,075.60
|
| Rate for Payer: University Health Alliance Commercial |
$5,213.60
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
|
PERSONA FEM PS POR STD SZ5 R
|
Facility
|
IP
|
$19,974.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,185.44 |
| Max. Negotiated Rate |
$19,374.78 |
| Rate for Payer: Cash Price |
$11,984.40
|
| Rate for Payer: Cash Price |
$4,440.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,180.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,981.80
|
| Rate for Payer: Health Management Network Commercial |
$6,290.00
|
| Rate for Payer: Health Management Network Commercial |
$16,977.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,660.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,976.60
|
| Rate for Payer: MDX Hawaii PPO |
$7,178.00
|
| Rate for Payer: MDX Hawaii PPO |
$19,374.78
|
| Rate for Payer: University Health Alliance Commercial |
$4,144.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,185.44
|
|
