|
17-Hydroxyprogesterone DLS
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
422834985
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
|
|
17-Hydroxyprogesterone DLS
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
422834985
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: AlohaCare Medicaid |
$268.50
|
| Rate for Payer: AlohaCare Medicare |
$225.54
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$494.04
|
| Rate for Payer: Devoted Health Medicare |
$225.54
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$37.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.17
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Humana Medicare |
$225.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.54
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.54
|
| Rate for Payer: University Health Alliance Commercial |
$70.21
|
|
|
1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 99223
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: AlohaCare Medicaid |
$174.14
|
| Rate for Payer: AlohaCare Medicare |
$156.50
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Devoted Health Medicare |
$156.50
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$149.55
|
| Rate for Payer: Health Management Network Commercial |
$495.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 99222
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$113.39 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: AlohaCare Medicaid |
$131.00
|
| Rate for Payer: AlohaCare Medicare |
$116.73
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Devoted Health Medicare |
$116.73
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.39
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 99221
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$68.50 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: AlohaCare Medicaid |
$82.48
|
| Rate for Payer: AlohaCare Medicare |
$73.69
|
| Rate for Payer: Cash Price |
$189.15
|
| Rate for Payer: Cash Price |
$189.15
|
| Rate for Payer: Cash Price |
$189.15
|
| Rate for Payer: Devoted Health Medicare |
$73.69
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.50
|
| Rate for Payer: Health Management Network Commercial |
$247.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
|
24 Hour Urine, Calcium DLS
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
422823405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
|
|
24 Hour Urine, Calcium DLS
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82340
|
| Hospital Charge Code |
422823405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$20.16
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$44.16
|
| Rate for Payer: Devoted Health Medicare |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$8.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.03
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Humana Medicare |
$20.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.16
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.16
|
| Rate for Payer: University Health Alliance Commercial |
$15.60
|
|
|
25690 Closed Trtmt of Lunate Dislocation, w/ Manip
|
Facility
|
OP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
440256900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: AlohaCare Medicaid |
$3,197.00
|
| Rate for Payer: AlohaCare Medicare |
$2,685.48
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,882.48
|
| Rate for Payer: Devoted Health Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,074.30
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Humana Medicare |
$2,685.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,685.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,685.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,685.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,685.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,660.59
|
|
|
25690 Closed Trtmt of Lunate Dislocation, w/ Manip
|
Facility
|
IP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
440256900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,434.90 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
|
|
29710 REMOVE SHOULDER OR HIP SPICA
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 29710
|
| Hospital Charge Code |
440297100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$297.36
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$651.36
|
| Rate for Payer: Devoted Health Medicare |
$297.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$297.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.36
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.36
|
| Rate for Payer: University Health Alliance Commercial |
$516.06
|
|
|
29710 REMOVE SHOULDER OR HIP SPICA
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 29710
|
| Hospital Charge Code |
440297100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
32960 Surgical Collapse Therapy Procedures on the
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS 32960
|
| Hospital Charge Code |
440329600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,984.62 |
| Rate for Payer: AlohaCare Medicaid |
$1,023.00
|
| Rate for Payer: AlohaCare Medicare |
$859.32
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,882.32
|
| Rate for Payer: Devoted Health Medicare |
$859.32
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$859.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,943.70
|
| Rate for Payer: Health Management Network Commercial |
$1,739.10
|
| Rate for Payer: Humana Medicare |
$859.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,841.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$859.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,984.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$859.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$859.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$859.32
|
| Rate for Payer: University Health Alliance Commercial |
$1,491.33
|
|
|
32960 Surgical Collapse Therapy Procedures on the
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS 32960
|
| Hospital Charge Code |
440329600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,739.10 |
| Max. Negotiated Rate |
$1,984.62 |
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Health Management Network Commercial |
$1,739.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,841.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,984.62
|
|
|
3 LAYER COMPRESSION BANDAGE SYSTEM
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
8817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
3 LAYER COMPRESSION BANDAGE SYSTEM
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
8817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$2.10
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$4.60
|
| Rate for Payer: Devoted Health Medicare |
$2.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$2.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.10
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.10
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
440112010 SKIN TAG REMOVAL EA 10 LES ED Charge
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
440112010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$184.00
|
| Rate for Payer: AlohaCare Medicare |
$154.56
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$338.56
|
| Rate for Payer: Devoted Health Medicare |
$154.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.60
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Humana Medicare |
$154.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.56
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.56
|
| Rate for Payer: University Health Alliance Commercial |
$268.24
|
|
|
440112010 SKIN TAG REMOVAL EA 10 LES ED Charge
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
440112010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
|
|
440113050 SH LES SCLP NK HND FT GN .5 CM ED Charge
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
440113050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.65 |
| Max. Negotiated Rate |
$416.13 |
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
|
|
440113050 SH LES SCLP NK HND FT GN .5 CM ED Charge
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
440113050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.50
|
| Rate for Payer: AlohaCare Medicare |
$180.18
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$394.68
|
| Rate for Payer: Devoted Health Medicare |
$180.18
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$407.55
|
| Rate for Payer: Health Management Network Commercial |
$364.65
|
| Rate for Payer: Humana Medicare |
$180.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.18
|
| Rate for Payer: MDX Hawaii PPO |
$416.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.18
|
| Rate for Payer: University Health Alliance Commercial |
$312.70
|
|
|
440205260 INJ THER CARPAL TUNNEL ED Charge
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
440205260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$517.50
|
| Rate for Payer: AlohaCare Medicare |
$434.70
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$952.20
|
| Rate for Payer: Devoted Health Medicare |
$434.70
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$983.25
|
| Rate for Payer: Health Management Network Commercial |
$879.75
|
| Rate for Payer: Humana Medicare |
$434.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$931.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,003.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.70
|
| Rate for Payer: University Health Alliance Commercial |
$754.41
|
|
|
440205260 INJ THER CARPAL TUNNEL ED Charge
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
440205260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$879.75 |
| Max. Negotiated Rate |
$1,003.95 |
| Rate for Payer: Cash Price |
$672.75
|
| Rate for Payer: Health Management Network Commercial |
$879.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$931.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,003.95
|
|
|
440213250 OPEN TRTMNT NASAL FX UNCOMPLIC ED Charge
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
440213250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$4,747.00
|
| Rate for Payer: AlohaCare Medicare |
$3,987.48
|
| Rate for Payer: Cash Price |
$6,171.10
|
| Rate for Payer: Cash Price |
$6,171.10
|
| Rate for Payer: Cash Price |
$6,171.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$8,734.48
|
| Rate for Payer: Devoted Health Medicare |
$3,987.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,987.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,019.30
|
| Rate for Payer: Health Management Network Commercial |
$8,069.90
|
| Rate for Payer: Humana Medicare |
$3,987.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,544.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,987.48
|
| Rate for Payer: MDX Hawaii PPO |
$9,209.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,987.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,987.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,987.48
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
440213250 OPEN TRTMNT NASAL FX UNCOMPLIC ED Charge
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
440213250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8,069.90 |
| Max. Negotiated Rate |
$9,209.18 |
| Rate for Payer: Cash Price |
$6,171.10
|
| Rate for Payer: Health Management Network Commercial |
$8,069.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,544.60
|
| Rate for Payer: MDX Hawaii PPO |
$9,209.18
|
|
|
440213360 OPN TRT NASAL SPTAL FX W WO STABLZTN ED
|
Facility
|
OP
|
$10,275.00
|
|
|
Service Code
|
HCPCS 21336
|
| Hospital Charge Code |
440213360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$5,137.50
|
| Rate for Payer: AlohaCare Medicare |
$4,315.50
|
| Rate for Payer: Cash Price |
$6,678.75
|
| Rate for Payer: Cash Price |
$6,678.75
|
| Rate for Payer: Cash Price |
$6,678.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$9,453.00
|
| Rate for Payer: Devoted Health Medicare |
$4,315.50
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,315.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,761.25
|
| Rate for Payer: Health Management Network Commercial |
$8,733.75
|
| Rate for Payer: Humana Medicare |
$4,315.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,315.50
|
| Rate for Payer: MDX Hawaii PPO |
$9,966.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,315.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,315.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,315.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
440213360 OPN TRT NASAL SPTAL FX W WO STABLZTN ED
|
Facility
|
IP
|
$10,275.00
|
|
|
Service Code
|
HCPCS 21336
|
| Hospital Charge Code |
440213360
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8,733.75 |
| Max. Negotiated Rate |
$9,966.75 |
| Rate for Payer: Cash Price |
$6,678.75
|
| Rate for Payer: Health Management Network Commercial |
$8,733.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,247.50
|
| Rate for Payer: MDX Hawaii PPO |
$9,966.75
|
|
