|
PERSONA FEM PS POR STD SZ5 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 SZ6 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 SZ6 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 SZ6 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 SZ6 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 SZ7 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 SZ7 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 SZ7 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 SZ7 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 SZ8 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 SZ8 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 SZ8 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 SZ8 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 SZ9 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 SZ9 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 SZ9 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 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: 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 KNEE 4 42-5580-004-02
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,780.00
|
| Rate for Payer: Health Management Network Commercial |
$4,590.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,860.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,238.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,024.00
|
|
|
PERSONA KNEE 4 42-5580-004-02
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$5,238.00 |
| Rate for Payer: AlohaCare Medicaid |
$2,700.00
|
| Rate for Payer: AlohaCare Medicare |
$4,104.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Devoted Health Medicare |
$4,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,104.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,780.00
|
| Rate for Payer: Health Management Network Commercial |
$4,590.00
|
| Rate for Payer: Humana Medicare |
$4,104.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,860.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,754.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,104.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,238.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,104.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,104.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,104.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,024.00
|
|
|
PERSONA LF SZ 2 42-5580-002-01
|
Facility
|
OP
|
$4,410.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.00 |
| Max. Negotiated Rate |
$4,277.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,205.00
|
| Rate for Payer: AlohaCare Medicare |
$3,351.60
|
| Rate for Payer: Cash Price |
$2,646.00
|
| Rate for Payer: Devoted Health Medicare |
$3,704.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,351.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network Commercial |
$3,748.50
|
| Rate for Payer: Humana Medicare |
$3,351.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,969.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,249.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,351.60
|
| Rate for Payer: MDX Hawaii PPO |
$4,277.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,351.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,351.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,351.60
|
| Rate for Payer: University Health Alliance Commercial |
$2,469.60
|
|
|
PERSONA LF SZ 2 42-5580-002-01
|
Facility
|
IP
|
$4,410.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.60 |
| Max. Negotiated Rate |
$4,277.70 |
| Rate for Payer: Cash Price |
$2,646.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,087.00
|
| Rate for Payer: Health Management Network Commercial |
$3,748.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,969.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,277.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,469.60
|
|
|
PERSONA LFT 4MM 42-5580-004-01
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.00 |
| Max. Negotiated Rate |
$3,249.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,675.00
|
| Rate for Payer: AlohaCare Medicare |
$2,546.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Devoted Health Medicare |
$2,814.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,546.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,345.00
|
| Rate for Payer: Health Management Network Commercial |
$2,847.50
|
| Rate for Payer: Humana Medicare |
$2,546.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,015.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,708.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,546.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,249.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,546.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,546.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,546.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,876.00
|
|
|
PERSONA LFT 4MM 42-5580-004-01
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.00 |
| Max. Negotiated Rate |
$3,249.50 |
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,345.00
|
| Rate for Payer: Health Management Network Commercial |
$2,847.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,015.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,249.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,876.00
|
|
|
PERSONA RIGHT J 42-5380-009-02
|
Facility
|
OP
|
$2,940.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$2,851.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,470.00
|
| Rate for Payer: AlohaCare Medicare |
$2,234.40
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Devoted Health Medicare |
$2,469.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,234.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,058.00
|
| Rate for Payer: Health Management Network Commercial |
$2,499.00
|
| Rate for Payer: Humana Medicare |
$2,234.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,646.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,499.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,234.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,851.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,234.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,234.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,234.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,646.40
|
|
|
PERSONA RIGHT J 42-5380-009-02
|
Facility
|
IP
|
$2,940.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.40 |
| Max. Negotiated Rate |
$2,851.80 |
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,058.00
|
| Rate for Payer: Health Management Network Commercial |
$2,499.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,646.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,851.80
|
| Rate for Payer: University Health Alliance Commercial |
$1,646.40
|
|
