|
440290490 APPLY CAST FIGURE OF EIGHT ED Charge
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29049
|
| Hospital Charge Code |
440290490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
440297150 REMOVE TURNBUCKLE JACKET ED Charge
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29715
|
| Hospital Charge Code |
440297150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$215.46
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$471.96
|
| Rate for Payer: Devoted Health Medicare |
$215.46
|
| 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 |
$215.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$215.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.46
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.46
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
440297150 REMOVE TURNBUCKLE JACKET ED Charge
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29715
|
| Hospital Charge Code |
440297150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
440297200 RPR SPICA BODY CAST JACKET ED Charge
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
440297200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$215.46
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$471.96
|
| Rate for Payer: Devoted Health Medicare |
$215.46
|
| 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 |
$215.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$215.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.46
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.46
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
440297200 RPR SPICA BODY CAST JACKET ED Charge
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
440297200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
440297400 WEDGING CAST EXCEPT CLUBFOOT ED Charge
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
440297400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
440297400 WEDGING CAST EXCEPT CLUBFOOT ED Charge
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29740
|
| Hospital Charge Code |
440297400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$215.46
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$471.96
|
| Rate for Payer: Devoted Health Medicare |
$215.46
|
| 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 |
$215.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$215.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.46
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.46
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
440297500 WEDGING CLUBFOOT CAST ED Charge
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29750
|
| Hospital Charge Code |
440297500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
440297500 WEDGING CLUBFOOT CAST ED Charge
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29750
|
| Hospital Charge Code |
440297500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$215.46
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Cash Price |
$333.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$471.96
|
| Rate for Payer: Devoted Health Medicare |
$215.46
|
| 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 |
$215.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$215.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.46
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.46
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
440360110 SEL CATH PLACE VENOUS 1ST ORD ED Charge
|
Facility
|
OP
|
$4,483.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
440360110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$4,348.51 |
| Rate for Payer: AlohaCare Medicaid |
$2,241.50
|
| Rate for Payer: AlohaCare Medicare |
$1,882.86
|
| Rate for Payer: Cash Price |
$2,913.95
|
| Rate for Payer: Cash Price |
$2,913.95
|
| Rate for Payer: Cash Price |
$2,913.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$4,124.36
|
| Rate for Payer: Devoted Health Medicare |
$1,882.86
|
| 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 |
$1,882.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,258.85
|
| Rate for Payer: Health Management Network Commercial |
$3,810.55
|
| Rate for Payer: Humana Medicare |
$1,882.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,034.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,882.86
|
| Rate for Payer: MDX Hawaii PPO |
$4,348.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,882.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,882.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,882.86
|
| Rate for Payer: University Health Alliance Commercial |
$3,267.66
|
|
|
440360110 SEL CATH PLACE VENOUS 1ST ORD ED Charge
|
Facility
|
IP
|
$4,483.00
|
|
|
Service Code
|
HCPCS 36011
|
| Hospital Charge Code |
440360110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,810.55 |
| Max. Negotiated Rate |
$4,348.51 |
| Rate for Payer: Cash Price |
$2,913.95
|
| Rate for Payer: Health Management Network Commercial |
$3,810.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,034.70
|
| Rate for Payer: MDX Hawaii PPO |
$4,348.51
|
|
|
440364000 VENIPUNC W PHYSSKILL >3YR FEM/JUG ED Cha
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 36400
|
| Hospital Charge Code |
440364000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$670.00
|
| Rate for Payer: AlohaCare Medicare |
$562.80
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,232.80
|
| Rate for Payer: Devoted Health Medicare |
$562.80
|
| 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 |
$562.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,273.00
|
| Rate for Payer: Health Management Network Commercial |
$1,139.00
|
| Rate for Payer: Humana Medicare |
$562.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,206.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$562.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,299.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$562.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.80
|
| Rate for Payer: University Health Alliance Commercial |
$976.73
|
|
|
440364000 VENIPUNC W PHYSSKILL >3YR FEM/JUG ED Cha
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 36400
|
| Hospital Charge Code |
440364000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,139.00 |
| Max. Negotiated Rate |
$1,299.80 |
| Rate for Payer: Cash Price |
$871.00
|
| Rate for Payer: Health Management Network Commercial |
$1,139.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,206.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,299.80
|
|
|
440364050 BL DRAW < 3 YRS SCALP VEIN ED Charge
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 36405
|
| Hospital Charge Code |
440364050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
440364050 BL DRAW < 3 YRS SCALP VEIN ED Charge
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 36405
|
| Hospital Charge Code |
440364050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$51.24
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$112.24
|
| Rate for Payer: Devoted Health Medicare |
$51.24
|
| 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 |
$51.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.90
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$51.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.24
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.24
|
| Rate for Payer: University Health Alliance Commercial |
$88.93
|
|
|
440364150 ROUTINE VENIPUNCTURE ED Charge
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
440364150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$8.50
|
| Rate for Payer: AlohaCare Medicare |
$7.14
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$15.64
|
| Rate for Payer: Devoted Health Medicare |
$7.14
|
| 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 |
$7.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Humana Medicare |
$7.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.14
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.14
|
| Rate for Payer: University Health Alliance Commercial |
$12.39
|
|
|
440364150 ROUTINE VENIPUNCTURE ED Charge
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
440364150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
|
|
440364160 CAPILLARY BLOOD COLLECTION ED Charge
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
440364160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
|
|
440364160 CAPILLARY BLOOD COLLECTION ED Charge
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
440364160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$8.50
|
| Rate for Payer: AlohaCare Medicare |
$7.14
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$15.64
|
| Rate for Payer: Devoted Health Medicare |
$7.14
|
| 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 |
$7.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Humana Medicare |
$7.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.14
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.14
|
| Rate for Payer: University Health Alliance Commercial |
$12.39
|
|
|
440365750 RPR CV CATH WO PORT PUMP ED Charge
|
Facility
|
OP
|
$2,383.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
440365750
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,191.50
|
| Rate for Payer: AlohaCare Medicare |
$1,000.86
|
| Rate for Payer: Cash Price |
$1,548.95
|
| Rate for Payer: Cash Price |
$1,548.95
|
| Rate for Payer: Cash Price |
$1,548.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2,192.36
|
| Rate for Payer: Devoted Health Medicare |
$1,000.86
|
| 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 |
$1,000.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,263.85
|
| Rate for Payer: Health Management Network Commercial |
$2,025.55
|
| Rate for Payer: Humana Medicare |
$1,000.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,144.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,000.86
|
| Rate for Payer: MDX Hawaii PPO |
$2,311.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,000.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,000.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,000.86
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
440365750 RPR CV CATH WO PORT PUMP ED Charge
|
Facility
|
IP
|
$2,383.00
|
|
|
Service Code
|
HCPCS 36575
|
| Hospital Charge Code |
440365750
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,025.55 |
| Max. Negotiated Rate |
$2,311.51 |
| Rate for Payer: Cash Price |
$1,548.95
|
| Rate for Payer: Health Management Network Commercial |
$2,025.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,144.70
|
| Rate for Payer: MDX Hawaii PPO |
$2,311.51
|
|
|
440365840 REPLACE COMPLETE PERIPHERAL VE ED Charge
|
Facility
|
IP
|
$4,339.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
440365840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,688.15 |
| Max. Negotiated Rate |
$4,208.83 |
| Rate for Payer: Cash Price |
$2,820.35
|
| Rate for Payer: Health Management Network Commercial |
$3,688.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,905.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,208.83
|
|
|
440365840 REPLACE COMPLETE PERIPHERAL VE ED Charge
|
Facility
|
OP
|
$4,339.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
440365840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,208.83 |
| Rate for Payer: AlohaCare Medicaid |
$2,169.50
|
| Rate for Payer: AlohaCare Medicare |
$1,822.38
|
| Rate for Payer: Cash Price |
$2,820.35
|
| Rate for Payer: Cash Price |
$2,820.35
|
| Rate for Payer: Cash Price |
$2,820.35
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$3,991.88
|
| Rate for Payer: Devoted Health Medicare |
$1,822.38
|
| 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 |
$1,822.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,122.05
|
| Rate for Payer: Health Management Network Commercial |
$3,688.15
|
| Rate for Payer: Humana Medicare |
$1,822.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,905.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,822.38
|
| Rate for Payer: MDX Hawaii PPO |
$4,208.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,822.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,822.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,822.38
|
| Rate for Payer: University Health Alliance Commercial |
$3,162.70
|
|
|
440437540 GI INTUBATION AND ASPIR DX SNGL SPEC ED
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
HCPCS 43754
|
| Hospital Charge Code |
440437540
|
|
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
|
|
|
440437540 GI INTUBATION AND ASPIR DX SNGL SPEC ED
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
HCPCS 43754
|
| Hospital Charge Code |
440437540
|
|
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
|
|
