|
hCG Urine Qualitative 2
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
422847030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
hCG Urine Qualitative 2
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
422847030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicare |
$57.96
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$126.96
|
| Rate for Payer: Devoted Health Medicare |
$57.96
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$57.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.96
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.96
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HCHG APP SKIN SUB GRFT FACE, NECK, FEET, WOUND 100CM2;1ST 25CM2
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
761152750
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$3,110.15 |
| Rate for Payer: AlohaCare Medicaid |
$93.15
|
| Rate for Payer: AlohaCare Medicare |
$83.83
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Devoted Health Medicare |
$83.83
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$93.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.98
|
| Rate for Payer: Health Management Network Commercial |
$3,110.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.83
|
| Rate for Payer: University Health Alliance Commercial |
$101.92
|
|
|
HCHG APP SKIN SUB GRFT FACE, NECK, FEET, WOUND 100CM2;EA ADDL 25CM2
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
761152760
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: AlohaCare Medicaid |
$24.45
|
| Rate for Payer: AlohaCare Medicare |
$21.52
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Devoted Health Medicare |
$21.52
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$24.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.66
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$28.94
|
|
|
HCHG APP SKIN SUB GRFT FACE, NECK, FEET, WOUND SURF >=100CM2;1ST 100CM2
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
761152770
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$3,110.15 |
| Rate for Payer: AlohaCare Medicaid |
$218.88
|
| Rate for Payer: AlohaCare Medicare |
$193.36
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Devoted Health Medicare |
$193.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$218.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$348.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$346.06
|
| Rate for Payer: Health Management Network Commercial |
$3,110.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$218.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.36
|
| Rate for Payer: University Health Alliance Commercial |
$257.54
|
|
|
HCHG APP SKIN SUB GRFT FACE, NECK, FEET, WOUND SURF >=100CM2;EA ADDL 100CM2
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
761152780
|
| Min. Negotiated Rate |
$47.23 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: AlohaCare Medicaid |
$54.23
|
| Rate for Payer: AlohaCare Medicare |
$47.23
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Devoted Health Medicare |
$47.23
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$54.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.23
|
| Rate for Payer: University Health Alliance Commercial |
$64.61
|
|
|
HCHG APP SKIN SUB GRFT TRUNK, ARMS, LEGS, WOUND 100CM2;1ST 25CM2
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
761152710
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$3,110.15 |
| Rate for Payer: AlohaCare Medicaid |
$83.87
|
| Rate for Payer: AlohaCare Medicare |
$74.85
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Devoted Health Medicare |
$74.85
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$83.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$130.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$3,110.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$83.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.85
|
| Rate for Payer: University Health Alliance Commercial |
$91.51
|
|
|
HCHG APP SKIN SUB GRFT TRUNK, ARMS, LEGS, WOUND 100CM2; EA ADDL 25CM2
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
761152720
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: AlohaCare Medicaid |
$16.51
|
| Rate for Payer: AlohaCare Medicare |
$14.31
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Devoted Health Medicare |
$14.31
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.12
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.31
|
| Rate for Payer: University Health Alliance Commercial |
$18.02
|
|
|
HCHG APP SKIN SUB GRFT TRUNK, ARMS, LEGS, WOUND SURF >=100CM2;1ST 100CM2
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
761152730
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: AlohaCare Medicaid |
$191.95
|
| Rate for Payer: AlohaCare Medicare |
$168.04
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Cash Price |
$2,600.00
|
| Rate for Payer: Devoted Health Medicare |
$168.04
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$191.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$323.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$319.54
|
| Rate for Payer: Health Management Network Commercial |
$3,400.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.04
|
| Rate for Payer: University Health Alliance Commercial |
$225.96
|
|
|
HCHG APP SKIN SUB GRFT TRUNK,ARMS, LEGS, WOUND SURF >=100CM2;EA ADDL 100CM2
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
761152700
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$3,110.15 |
| Rate for Payer: AlohaCare Medicaid |
$43.19
|
| Rate for Payer: AlohaCare Medicare |
$37.70
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Devoted Health Medicare |
$37.70
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$43.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$73.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.70
|
| Rate for Payer: Health Management Network Commercial |
$3,110.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.70
|
| Rate for Payer: University Health Alliance Commercial |
$51.52
|
|
|
HCHG BX BONE SUPERFICIAL
|
Professional
|
Both
|
$3,241.00
|
|
|
Service Code
|
HCPCS 20220
|
| Hospital Charge Code |
761202200
|
| Min. Negotiated Rate |
$76.43 |
| Max. Negotiated Rate |
$2,754.85 |
| Rate for Payer: AlohaCare Medicaid |
$86.98
|
| Rate for Payer: AlohaCare Medicare |
$76.43
|
| Rate for Payer: Cash Price |
$2,106.65
|
| Rate for Payer: Cash Price |
$2,106.65
|
| Rate for Payer: Devoted Health Medicare |
$76.43
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$86.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.18
|
| Rate for Payer: Health Management Network Commercial |
$2,754.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.43
|
| Rate for Payer: University Health Alliance Commercial |
$115.07
|
|
|
HCHG CL TX METATARSAL FX; W MANIPULATION
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
761282850
|
| Min. Negotiated Rate |
$216.84 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: AlohaCare Medicaid |
$248.62
|
| Rate for Payer: AlohaCare Medicare |
$234.53
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$234.53
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$248.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$216.84
|
| Rate for Payer: Health Management Network Commercial |
$408.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$281.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$248.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$248.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.53
|
| Rate for Payer: University Health Alliance Commercial |
$360.00
|
|
|
HCHG CL TX METATARSAL FX; WO MANIPULATION
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
761284700
|
| Min. Negotiated Rate |
$184.86 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: AlohaCare Medicaid |
$228.27
|
| Rate for Payer: AlohaCare Medicare |
$222.89
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$222.89
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$228.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.86
|
| Rate for Payer: Health Management Network Commercial |
$408.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$267.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$228.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$228.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.89
|
| Rate for Payer: University Health Alliance Commercial |
$320.00
|
|
|
HCHG COMPLEX DRAINAGE POSTOP WOUND INFECTION
|
Professional
|
Both
|
$4,840.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
761101800
|
| Min. Negotiated Rate |
$126.62 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: AlohaCare Medicaid |
$184.76
|
| Rate for Payer: AlohaCare Medicare |
$180.19
|
| Rate for Payer: Cash Price |
$3,146.00
|
| Rate for Payer: Cash Price |
$3,146.00
|
| Rate for Payer: Devoted Health Medicare |
$180.19
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$184.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$284.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$4,114.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$216.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$216.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.19
|
| Rate for Payer: University Health Alliance Commercial |
$210.20
|
|
|
HCHG CORRECTION HAMMERTOE
|
Professional
|
Both
|
$6,490.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
761282850
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$5,516.50 |
| Rate for Payer: AlohaCare Medicaid |
$409.22
|
| Rate for Payer: AlohaCare Medicare |
$384.91
|
| Rate for Payer: Cash Price |
$4,218.50
|
| Rate for Payer: Cash Price |
$4,218.50
|
| Rate for Payer: Devoted Health Medicare |
$384.91
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$409.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$597.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$384.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$5,516.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$461.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$461.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$409.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$384.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$409.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$384.91
|
| Rate for Payer: University Health Alliance Commercial |
$511.86
|
|
|
HCHG DEBRIDEMENT, BONE, 1ST 20 SQ CM OR LESS
|
Professional
|
Both
|
$2,669.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
761110440
|
| Min. Negotiated Rate |
$198.39 |
| Max. Negotiated Rate |
$2,268.65 |
| Rate for Payer: AlohaCare Medicaid |
$223.77
|
| Rate for Payer: AlohaCare Medicare |
$198.39
|
| Rate for Payer: Cash Price |
$1,734.85
|
| Rate for Payer: Cash Price |
$1,734.85
|
| Rate for Payer: Devoted Health Medicare |
$198.39
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$223.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$429.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.52
|
| Rate for Payer: Health Management Network Commercial |
$2,268.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$238.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.39
|
| Rate for Payer: University Health Alliance Commercial |
$450.00
|
|
|
HCHG DEBRIDEMENT, BONE, EA ADDL 20 SQ CM OR PART THEREOF
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
761110470
|
| Min. Negotiated Rate |
$82.26 |
| Max. Negotiated Rate |
$2,125.85 |
| Rate for Payer: AlohaCare Medicaid |
$94.37
|
| Rate for Payer: AlohaCare Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$1,625.65
|
| Rate for Payer: Cash Price |
$1,625.65
|
| Rate for Payer: Devoted Health Medicare |
$82.26
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$94.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$137.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.26
|
| Rate for Payer: Health Management Network Commercial |
$2,125.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.26
|
| Rate for Payer: University Health Alliance Commercial |
$109.82
|
|
|
HCHG DEBRIDEMENT, MUSCLE/FASCIA, 1ST 20 SQ CM OR LESS
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
761110460
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: AlohaCare Medicaid |
$153.95
|
| Rate for Payer: AlohaCare Medicare |
$137.36
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Devoted Health Medicare |
$137.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$153.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$316.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.22
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.36
|
|
|
HCHG DEBRIDEMENT, MUSCLE/FASCIA, EA ADDL 20 SQ CM OR PART THEREOF
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
761110460
|
| Min. Negotiated Rate |
$46.19 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: AlohaCare Medicaid |
$53.52
|
| Rate for Payer: AlohaCare Medicare |
$46.19
|
| Rate for Payer: Cash Price |
$523.25
|
| Rate for Payer: Cash Price |
$523.25
|
| Rate for Payer: Devoted Health Medicare |
$46.19
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$53.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$79.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.19
|
| Rate for Payer: Health Management Network Commercial |
$684.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.19
|
| Rate for Payer: University Health Alliance Commercial |
$62.70
|
|
|
HCHG DRESSINGS/DEBRIDEMENT OF PARTIAL-THICKNESS BURNS,INIT/SUBQ; LARGE
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
761160300
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: AlohaCare Medicaid |
$132.54
|
| Rate for Payer: AlohaCare Medicare |
$122.45
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Devoted Health Medicare |
$122.45
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$132.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$205.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.42
|
| Rate for Payer: Health Management Network Commercial |
$680.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.45
|
|
|
HCHG INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
761101200
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: AlohaCare Medicaid |
$113.02
|
| Rate for Payer: AlohaCare Medicare |
$108.15
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Devoted Health Medicare |
$108.15
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$113.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$160.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$680.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.15
|
| Rate for Payer: University Health Alliance Commercial |
$125.09
|
|
|
HCHG OSTECTOMY PRTL 5TH METAR HEAD SPX
|
Professional
|
Both
|
$6,490.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
761281100
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$5,516.50 |
| Rate for Payer: AlohaCare Medicaid |
$311.24
|
| Rate for Payer: AlohaCare Medicare |
$293.52
|
| Rate for Payer: Cash Price |
$4,218.50
|
| Rate for Payer: Cash Price |
$4,218.50
|
| Rate for Payer: Devoted Health Medicare |
$293.52
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$311.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$467.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$293.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$5,516.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$352.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$352.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$311.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$293.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$311.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$293.52
|
| Rate for Payer: University Health Alliance Commercial |
$389.51
|
|
|
HCHG SECONDARY CLOSURE SURG WOUND/DEHSN EXTESV/COMPLIC
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
761281100
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$3,110.15 |
| Rate for Payer: AlohaCare Medicaid |
$813.50
|
| Rate for Payer: AlohaCare Medicare |
$749.47
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Cash Price |
$2,378.35
|
| Rate for Payer: Devoted Health Medicare |
$749.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$749.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network Commercial |
$3,110.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$899.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$899.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$899.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$813.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$749.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$813.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$749.47
|
| Rate for Payer: University Health Alliance Commercial |
$935.34
|
|
|
HC LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY
|
Professional
|
Both
|
$597.00
|
|
|
Service Code
|
HCPCS 97610
|
| Hospital Charge Code |
761976100
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: AlohaCare Medicaid |
$18.09
|
| Rate for Payer: AlohaCare Medicare |
$15.50
|
| Rate for Payer: Cash Price |
$388.05
|
| Rate for Payer: Cash Price |
$388.05
|
| Rate for Payer: Devoted Health Medicare |
$15.50
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$18.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.02
|
| Rate for Payer: Health Management Network Commercial |
$507.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.18
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Professional
|
Both
|
$597.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
761976050
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: AlohaCare Medicaid |
$24.61
|
| Rate for Payer: AlohaCare Medicare |
$21.27
|
| Rate for Payer: Cash Price |
$388.05
|
| Rate for Payer: Cash Price |
$388.05
|
| Rate for Payer: Devoted Health Medicare |
$21.27
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$24.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.67
|
| Rate for Payer: Health Management Network Commercial |
$507.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.27
|
| Rate for Payer: University Health Alliance Commercial |
$30.44
|
|
