|
ibuprofen 400 mg Tab [KMC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 65162046410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
ICF ROOM BOARD PVT
|
Facility
|
IP
|
$1,800.00
|
|
| Hospital Charge Code |
1701001
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$2,811.74
|
| Rate for Payer: AlohaCare Medicare |
$2,638.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,803.60
|
| Rate for Payer: Devoted Health Medicare |
$2,638.00
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,638.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$1,530.00
|
| Rate for Payer: Humana Medicare |
$2,638.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,620.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,811.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,638.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,746.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,811.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,638.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,811.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,638.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ICF SWING RB PVT
|
Facility
|
IP
|
$1,800.00
|
|
| Hospital Charge Code |
1702001
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$5,923.00 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$2,289.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,035.80
|
| Rate for Payer: Devoted Health Medicare |
$2,289.00
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,289.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,530.00
|
| Rate for Payer: Humana Medicare |
$2,289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,620.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,811.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,289.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,746.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,289.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,811.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,289.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
icosapent 1 gm Cap [KMC]
|
Facility
|
OP
|
$12.58
|
|
|
Service Code
|
NDC 72603012901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: AlohaCare Medicaid |
$6.29
|
| Rate for Payer: AlohaCare Medicare |
$5.28
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$11.57
|
| Rate for Payer: Devoted Health Medicare |
$5.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.95
|
| Rate for Payer: Health Management Network Commercial |
$10.69
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.28
|
| Rate for Payer: MDX Hawaii PPO |
$12.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.28
|
| Rate for Payer: University Health Alliance Commercial |
$9.17
|
|
|
icosapent 1 gm Cap [KMC]
|
Facility
|
IP
|
$12.58
|
|
|
Service Code
|
NDC 72603012901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$12.20 |
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Health Management Network Commercial |
$10.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.32
|
| Rate for Payer: MDX Hawaii PPO |
$12.20
|
|
|
I&D ABSCESS COMPLEX ED Charge
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
440100610
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
I&D ABSCESS COMPLEX ED Charge
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
440100610
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.72 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$342.72
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$750.72
|
| Rate for Payer: Devoted Health Medicare |
$342.72
|
| 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 |
$342.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.72
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.72
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
I&D ABSCESS SIMPLE ED Charge
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
440100600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.72 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$342.72
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$750.72
|
| Rate for Payer: Devoted Health Medicare |
$342.72
|
| 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 |
$342.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.72
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.72
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
I&D ABSCESS SIMPLE ED Charge
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
440100600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
I&D BELOW FASCIA FOOT 1 BURSAL SPACE
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 28002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: AlohaCare Medicaid |
$141.53
|
| Rate for Payer: AlohaCare Medicare |
$127.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Devoted Health Medicare |
$127.59
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$141.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.84
|
| Rate for Payer: Health Management Network Commercial |
$387.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.59
|
| Rate for Payer: University Health Alliance Commercial |
$516.00
|
|
|
I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$801.00
|
|
|
Service Code
|
HCPCS 28003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.79 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: AlohaCare Medicaid |
$257.54
|
| Rate for Payer: AlohaCare Medicare |
$228.79
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Cash Price |
$520.65
|
| Rate for Payer: Devoted Health Medicare |
$228.79
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$257.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$792.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$375.18
|
| Rate for Payer: Health Management Network Commercial |
$680.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$274.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$274.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$257.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.79
|
| Rate for Payer: University Health Alliance Commercial |
$793.00
|
|
|
I&D HEMATOMA ED Charge
|
Facility
|
OP
|
$4,314.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
440101400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,157.00
|
| Rate for Payer: AlohaCare Medicare |
$1,811.88
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$3,968.88
|
| Rate for Payer: Devoted Health Medicare |
$1,811.88
|
| 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 |
$1,811.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,098.30
|
| Rate for Payer: Health Management Network Commercial |
$3,666.90
|
| Rate for Payer: Humana Medicare |
$1,811.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,882.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,811.88
|
| Rate for Payer: MDX Hawaii PPO |
$4,184.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,811.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,811.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,811.88
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
I&D HEMATOMA ED Charge
|
Facility
|
IP
|
$4,314.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
440101400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,666.90 |
| Max. Negotiated Rate |
$4,184.58 |
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Health Management Network Commercial |
$3,666.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,882.60
|
| Rate for Payer: MDX Hawaii PPO |
$4,184.58
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$3,082.00
|
|
|
Service Code
|
HCPCS 10140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$2,619.70 |
| Rate for Payer: AlohaCare Medicaid |
$124.60
|
| Rate for Payer: AlohaCare Medicare |
$120.44
|
| Rate for Payer: Cash Price |
$2,003.30
|
| Rate for Payer: Cash Price |
$2,003.30
|
| Rate for Payer: Devoted Health Medicare |
$120.44
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$124.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$2,619.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.44
|
| Rate for Payer: University Health Alliance Commercial |
$140.50
|
|
|
I & D OF ABSCESS, VULVA/PERI CHARGE
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
440564050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$823.65 |
| Max. Negotiated Rate |
$939.93 |
| Rate for Payer: Cash Price |
$629.85
|
| Rate for Payer: Health Management Network Commercial |
$823.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$872.10
|
| Rate for Payer: MDX Hawaii PPO |
$939.93
|
|
|
I & D OF ABSCESS, VULVA/PERI CHARGE
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
440564050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.98 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$484.50
|
| Rate for Payer: AlohaCare Medicare |
$406.98
|
| Rate for Payer: Cash Price |
$629.85
|
| Rate for Payer: Cash Price |
$629.85
|
| Rate for Payer: Cash Price |
$629.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$891.48
|
| Rate for Payer: Devoted Health Medicare |
$406.98
|
| 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 |
$406.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$920.55
|
| Rate for Payer: Health Management Network Commercial |
$823.65
|
| Rate for Payer: Humana Medicare |
$406.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$872.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$406.98
|
| Rate for Payer: MDX Hawaii PPO |
$939.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$406.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$406.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$406.98
|
| Rate for Payer: University Health Alliance Commercial |
$706.30
|
|
|
I&D OF BARTHOLIN'S GLAND ABCESS Charge
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
440564200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$324.00
|
| Rate for Payer: AlohaCare Medicare |
$272.16
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$596.16
|
| Rate for Payer: Devoted Health Medicare |
$272.16
|
| 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 |
$272.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$615.60
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Humana Medicare |
$272.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.16
|
| Rate for Payer: MDX Hawaii PPO |
$628.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$272.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.16
|
| Rate for Payer: University Health Alliance Commercial |
$472.33
|
|
|
I&D OF BARTHOLIN'S GLAND ABCESS Charge
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
440564200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$628.56 |
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Health Management Network Commercial |
$550.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$583.20
|
| Rate for Payer: MDX Hawaii PPO |
$628.56
|
|
|
I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 56420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: AlohaCare Medicaid |
$116.29
|
| Rate for Payer: AlohaCare Medicare |
$103.05
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Devoted Health Medicare |
$103.05
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$116.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$159.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.50
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.05
|
| Rate for Payer: University Health Alliance Commercial |
$153.72
|
|
|
I&D PILONIDAL CYST COMPLX ED Charge
|
Facility
|
OP
|
$4,314.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
440100810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,184.58 |
| Rate for Payer: AlohaCare Medicaid |
$2,157.00
|
| Rate for Payer: AlohaCare Medicare |
$1,811.88
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$3,968.88
|
| Rate for Payer: Devoted Health Medicare |
$1,811.88
|
| 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 |
$1,811.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,098.30
|
| Rate for Payer: Health Management Network Commercial |
$3,666.90
|
| Rate for Payer: Humana Medicare |
$1,811.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,882.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,811.88
|
| Rate for Payer: MDX Hawaii PPO |
$4,184.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,811.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,811.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,811.88
|
| Rate for Payer: University Health Alliance Commercial |
$3,144.47
|
|
|
I&D PILONIDAL CYST COMPLX ED Charge
|
Facility
|
IP
|
$4,314.00
|
|
|
Service Code
|
HCPCS 10081
|
| Hospital Charge Code |
440100810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,666.90 |
| Max. Negotiated Rate |
$4,184.58 |
| Rate for Payer: Cash Price |
$2,804.10
|
| Rate for Payer: Health Management Network Commercial |
$3,666.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,882.60
|
| Rate for Payer: MDX Hawaii PPO |
$4,184.58
|
|
|
I&D PILONIDAL CYST SIMPLE ED Charge
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
440100800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$342.72
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$750.72
|
| Rate for Payer: Devoted Health Medicare |
$342.72
|
| 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 |
$342.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$342.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.72
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.72
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
I&D PILONIDAL CYST SIMPLE ED Charge
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 10080
|
| Hospital Charge Code |
440100800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
I & D RECTAL ABSCESS CHARGE
|
Facility
|
IP
|
$7,251.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
440460400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,163.35 |
| Max. Negotiated Rate |
$7,033.47 |
| Rate for Payer: Cash Price |
$4,713.15
|
| Rate for Payer: Health Management Network Commercial |
$6,163.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,525.90
|
| Rate for Payer: MDX Hawaii PPO |
$7,033.47
|
|
|
I & D RECTAL ABSCESS CHARGE
|
Facility
|
OP
|
$7,251.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
440460400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$7,033.47 |
| Rate for Payer: AlohaCare Medicaid |
$3,625.50
|
| Rate for Payer: AlohaCare Medicare |
$3,045.42
|
| Rate for Payer: Cash Price |
$4,713.15
|
| Rate for Payer: Cash Price |
$4,713.15
|
| Rate for Payer: Cash Price |
$4,713.15
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$6,670.92
|
| Rate for Payer: Devoted Health Medicare |
$3,045.42
|
| 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 |
$3,045.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,888.45
|
| Rate for Payer: Health Management Network Commercial |
$6,163.35
|
| Rate for Payer: Humana Medicare |
$3,045.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,525.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,045.42
|
| Rate for Payer: MDX Hawaii PPO |
$7,033.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,045.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,045.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,045.42
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
