|
CLOSED TREATMENT OF DISTAL TIBIA FRACTURE WT BEARI
|
Facility
|
IP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
440278250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,434.90 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
|
|
CLOSED TREATMENT OF DISTAL TIBIA FRACTURE WT BEARI
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
440278240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF DISTAL TIBIA FRACTURE WT BEARI
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
440278240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF DISTAL TIBIA FRACTURE WT BEARI
|
Facility
|
OP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
440278250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: AlohaCare Medicaid |
$3,197.00
|
| Rate for Payer: AlohaCare Medicare |
$2,685.48
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,882.48
|
| Rate for Payer: Devoted Health Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,074.30
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Humana Medicare |
$2,685.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,685.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,685.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,685.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,685.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,660.59
|
|
|
CLOSED TREATMENT OF FEMORAL FRACTURE DISTAL END ME
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
440275100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF FEMORAL FRACTURE DISTAL END ME
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
440275100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITH MA
|
Facility
|
OP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
440275020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: AlohaCare Medicaid |
$3,197.00
|
| Rate for Payer: AlohaCare Medicare |
$2,685.48
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,882.48
|
| Rate for Payer: Devoted Health Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,074.30
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Humana Medicare |
$2,685.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,685.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,685.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,685.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,685.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,660.59
|
|
|
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITH MA
|
Facility
|
IP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
440275020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,434.90 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
|
|
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITHOUT
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
440275000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE WITHOUT
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
440275000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
440272460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
440272460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE MEDI
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
440245770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE MEDI
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
440245760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE MEDI
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 24577
|
| Hospital Charge Code |
440245770
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE MEDI
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
440245760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF INTERCONDYLAR SPINES AND OR TU
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
440275380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF INTERCONDYLAR SPINES AND OR TU
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
440275380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF KNEE DISLOCATION REQUIRING ANE
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
440275500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
|
CLOSED TREATMENT OF KNEE DISLOCATION REQUIRING ANE
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
440275500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.95 |
| Max. Negotiated Rate |
$860.39 |
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
|
|
CLOSED TREATMENT OF MANDIBULAR FRACTURE WITHOUT MA
|
Facility
|
IP
|
$1,335.00
|
|
|
Service Code
|
HCPCS 21450
|
| Hospital Charge Code |
440214500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,134.75 |
| Max. Negotiated Rate |
$1,294.95 |
| Rate for Payer: Cash Price |
$867.75
|
| Rate for Payer: Health Management Network Commercial |
$1,134.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,201.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,294.95
|
|
|
CLOSED TREATMENT OF MANDIBULAR FRACTURE WITHOUT MA
|
Facility
|
OP
|
$1,335.00
|
|
|
Service Code
|
HCPCS 21450
|
| Hospital Charge Code |
440214500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$667.50
|
| Rate for Payer: AlohaCare Medicare |
$560.70
|
| Rate for Payer: Cash Price |
$867.75
|
| Rate for Payer: Cash Price |
$867.75
|
| Rate for Payer: Cash Price |
$867.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,228.20
|
| Rate for Payer: Devoted Health Medicare |
$560.70
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$560.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,268.25
|
| Rate for Payer: Health Management Network Commercial |
$1,134.75
|
| Rate for Payer: Humana Medicare |
$560.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,201.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$560.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,294.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$560.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$560.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$560.70
|
| Rate for Payer: University Health Alliance Commercial |
$973.08
|
|
|
CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISL
|
Facility
|
OP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 28635
|
| Hospital Charge Code |
440286350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: AlohaCare Medicaid |
$3,197.00
|
| Rate for Payer: AlohaCare Medicare |
$2,685.48
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5,882.48
|
| Rate for Payer: Devoted Health Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,685.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,074.30
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Humana Medicare |
$2,685.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,685.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,685.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,685.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,685.48
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISL
|
Facility
|
IP
|
$6,394.00
|
|
|
Service Code
|
HCPCS 28635
|
| Hospital Charge Code |
440286350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,434.90 |
| Max. Negotiated Rate |
$6,202.18 |
| Rate for Payer: Cash Price |
$4,156.10
|
| Rate for Payer: Health Management Network Commercial |
$5,434.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,754.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,202.18
|
|
|
CLOSED TREATMENT OF PATELLAR FRACTURE WITHOUT MANI
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
440275200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$443.50
|
| Rate for Payer: AlohaCare Medicare |
$372.54
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Cash Price |
$576.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$816.04
|
| Rate for Payer: Devoted Health Medicare |
$372.54
|
| 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 |
$372.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$842.65
|
| Rate for Payer: Health Management Network Commercial |
$753.95
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$798.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$372.54
|
| Rate for Payer: MDX Hawaii PPO |
$860.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$372.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.54
|
| Rate for Payer: University Health Alliance Commercial |
$646.53
|
|
