|
REMOVAL FOREIGN BODY; EYE CHARGE
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
440652050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
|
|
REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
HCPCS 28193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$964.75 |
| Rate for Payer: AlohaCare Medicaid |
$382.81
|
| Rate for Payer: AlohaCare Medicare |
$351.55
|
| Rate for Payer: Cash Price |
$737.75
|
| Rate for Payer: Cash Price |
$737.75
|
| Rate for Payer: Devoted Health Medicare |
$351.55
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$382.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$584.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$351.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$344.50
|
| Rate for Payer: Health Management Network Commercial |
$964.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$421.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$421.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$421.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$382.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$351.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$382.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$351.55
|
| Rate for Payer: University Health Alliance Commercial |
$494.84
|
|
|
REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 28192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.30 |
| Max. Negotiated Rate |
$853.40 |
| Rate for Payer: AlohaCare Medicaid |
$326.24
|
| Rate for Payer: AlohaCare Medicare |
$303.92
|
| Rate for Payer: Cash Price |
$652.60
|
| Rate for Payer: Cash Price |
$652.60
|
| Rate for Payer: Devoted Health Medicare |
$303.92
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$326.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$497.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$274.30
|
| Rate for Payer: Health Management Network Commercial |
$853.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$364.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$364.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$303.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$326.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.92
|
| Rate for Payer: University Health Alliance Commercial |
$421.14
|
|
|
REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$713.00
|
|
|
Service Code
|
HCPCS 28190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$606.05 |
| Rate for Payer: AlohaCare Medicaid |
$139.11
|
| Rate for Payer: AlohaCare Medicare |
$132.19
|
| Rate for Payer: Cash Price |
$463.45
|
| Rate for Payer: Cash Price |
$463.45
|
| Rate for Payer: Devoted Health Medicare |
$132.19
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$139.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.24
|
| Rate for Payer: Health Management Network Commercial |
$606.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.19
|
| Rate for Payer: University Health Alliance Commercial |
$172.62
|
|
|
REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 20520
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: AlohaCare Medicaid |
$155.87
|
| Rate for Payer: AlohaCare Medicare |
$147.90
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Devoted Health Medicare |
$147.90
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$155.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$238.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.90
|
| Rate for Payer: University Health Alliance Commercial |
$201.87
|
|
|
REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$32.51
|
| Rate for Payer: AlohaCare Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$26.76
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$32.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.48
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.76
|
|
|
REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: AlohaCare Medicaid |
$18.16
|
| Rate for Payer: AlohaCare Medicare |
$19.18
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$19.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.82
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.18
|
|
|
REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 20680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.74 |
| Max. Negotiated Rate |
$668.72 |
| Rate for Payer: AlohaCare Medicaid |
$435.82
|
| Rate for Payer: AlohaCare Medicare |
$402.16
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Devoted Health Medicare |
$402.16
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$435.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$668.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.74
|
| Rate for Payer: Health Management Network Commercial |
$402.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$482.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$435.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$435.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.16
|
| Rate for Payer: University Health Alliance Commercial |
$542.81
|
|
|
REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 58301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: AlohaCare Medicaid |
$65.32
|
| Rate for Payer: AlohaCare Medicare |
$56.11
|
| Rate for Payer: Cash Price |
$176.15
|
| Rate for Payer: Cash Price |
$176.15
|
| Rate for Payer: Devoted Health Medicare |
$56.11
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$65.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.14
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.11
|
| Rate for Payer: University Health Alliance Commercial |
$80.61
|
|
|
REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 11982
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: AlohaCare Medicaid |
$72.04
|
| Rate for Payer: AlohaCare Medicare |
$61.50
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Devoted Health Medicare |
$61.50
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$72.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$142.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.22
|
| Rate for Payer: Health Management Network Commercial |
$391.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.91
|
|
|
REMOVAL OF FOREIGN BODY, ARM CHARGE
|
Facility
|
OP
|
$3,272.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
440242000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,636.00
|
| Rate for Payer: AlohaCare Medicare |
$1,374.24
|
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$3,010.24
|
| Rate for Payer: Devoted Health Medicare |
$1,374.24
|
| 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 |
$1,374.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,108.40
|
| Rate for Payer: Health Management Network Commercial |
$2,781.20
|
| Rate for Payer: Humana Medicare |
$1,374.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,944.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,374.24
|
| Rate for Payer: MDX Hawaii PPO |
$3,173.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,374.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,374.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,374.24
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
REMOVAL OF FOREIGN BODY, ARM CHARGE
|
Facility
|
IP
|
$3,272.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
440242000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,781.20 |
| Max. Negotiated Rate |
$3,173.84 |
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Health Management Network Commercial |
$2,781.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,944.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,173.84
|
|
|
REMOVAL OF FOREIGN BODY EYELID EMBEDDED CHARGE
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
440679380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.02 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$465.50
|
| Rate for Payer: AlohaCare Medicare |
$391.02
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$856.52
|
| Rate for Payer: Devoted Health Medicare |
$391.02
|
| 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 |
$391.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$884.45
|
| Rate for Payer: Health Management Network Commercial |
$791.35
|
| Rate for Payer: Humana Medicare |
$391.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$837.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.02
|
| Rate for Payer: MDX Hawaii PPO |
$903.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$391.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$391.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$391.02
|
| Rate for Payer: University Health Alliance Commercial |
$678.61
|
|
|
REMOVAL OF FOREIGN BODY EYELID EMBEDDED CHARGE
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
440679380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$903.07 |
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Health Management Network Commercial |
$791.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$837.90
|
| Rate for Payer: MDX Hawaii PPO |
$903.07
|
|
|
REMOVAL OF FOREIGN BODY FOOT DEEP CHARGE
|
Facility
|
OP
|
$5,853.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
440281920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$5,677.41 |
| Rate for Payer: AlohaCare Medicaid |
$2,926.50
|
| Rate for Payer: AlohaCare Medicare |
$2,458.26
|
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,384.76
|
| Rate for Payer: Devoted Health Medicare |
$2,458.26
|
| 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 |
$2,458.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,560.35
|
| Rate for Payer: Health Management Network Commercial |
$4,975.05
|
| Rate for Payer: Humana Medicare |
$2,458.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,267.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,458.26
|
| Rate for Payer: MDX Hawaii PPO |
$5,677.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,458.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,458.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,458.26
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
REMOVAL OF FOREIGN BODY FOOT DEEP CHARGE
|
Facility
|
IP
|
$5,853.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
440281920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,975.05 |
| Max. Negotiated Rate |
$5,677.41 |
| Rate for Payer: Cash Price |
$3,804.45
|
| Rate for Payer: Health Management Network Commercial |
$4,975.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,267.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,677.41
|
|
|
REMOVAL OF FOREIGN BODY/NARE CHARGE
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
440303000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.55 |
| Max. Negotiated Rate |
$487.91 |
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Health Management Network Commercial |
$427.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.70
|
| Rate for Payer: MDX Hawaii PPO |
$487.91
|
|
|
REMOVAL OF FOREIGN BODY/NARE CHARGE
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
440303000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.26 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$251.50
|
| Rate for Payer: AlohaCare Medicare |
$211.26
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Cash Price |
$326.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$462.76
|
| Rate for Payer: Devoted Health Medicare |
$211.26
|
| 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 |
$211.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$477.85
|
| Rate for Payer: Health Management Network Commercial |
$427.55
|
| Rate for Payer: Humana Medicare |
$211.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.26
|
| Rate for Payer: MDX Hawaii PPO |
$487.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.26
|
| Rate for Payer: University Health Alliance Commercial |
$366.64
|
|
|
REMOVAL OF FOREIGN BODY PELVIS/HIP SUBCUTANEOUS CH
|
Facility
|
IP
|
$3,272.00
|
|
|
Service Code
|
HCPCS 27086
|
| Hospital Charge Code |
440270860
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,781.20 |
| Max. Negotiated Rate |
$3,173.84 |
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Health Management Network Commercial |
$2,781.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,944.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,173.84
|
|
|
REMOVAL OF FOREIGN BODY PELVIS/HIP SUBCUTANEOUS CH
|
Facility
|
OP
|
$3,272.00
|
|
|
Service Code
|
HCPCS 27086
|
| Hospital Charge Code |
440270860
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,636.00
|
| Rate for Payer: AlohaCare Medicare |
$1,374.24
|
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Cash Price |
$2,126.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$3,010.24
|
| Rate for Payer: Devoted Health Medicare |
$1,374.24
|
| 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 |
$1,374.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,108.40
|
| Rate for Payer: Health Management Network Commercial |
$2,781.20
|
| Rate for Payer: Humana Medicare |
$1,374.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,944.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,374.24
|
| Rate for Payer: MDX Hawaii PPO |
$3,173.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,374.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,374.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,374.24
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
REMOVAL OF SUTURES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS S0630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$46.52 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.52
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
|
|
REMOVE FOREIGN BODY, EYE CHARGE
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
440652200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
|
|
REMOVE FOREIGN BODY, EYE CHARGE
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
440652200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.74 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$198.50
|
| Rate for Payer: AlohaCare Medicare |
$166.74
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$365.24
|
| Rate for Payer: Devoted Health Medicare |
$166.74
|
| 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 |
$166.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.15
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Humana Medicare |
$166.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.74
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.74
|
| Rate for Payer: University Health Alliance Commercial |
$289.37
|
|
|
REMOVE INPACTED EARWAX Charge
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
440692100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$266.75 |
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
|
|
REMOVE INPACTED EARWAX Charge
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
440692100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$137.50
|
| Rate for Payer: AlohaCare Medicare |
$115.50
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Cash Price |
$178.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$253.00
|
| Rate for Payer: Devoted Health Medicare |
$115.50
|
| 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 |
$115.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$261.25
|
| Rate for Payer: Health Management Network Commercial |
$233.75
|
| Rate for Payer: Humana Medicare |
$115.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$247.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.50
|
| Rate for Payer: MDX Hawaii PPO |
$266.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
