|
CT HEAD BRAIN W CON
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
HCPCS 70460
|
| Hospital Charge Code |
424704600
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$1,592.74 |
| Rate for Payer: AlohaCare Medicaid |
$821.00
|
| Rate for Payer: AlohaCare Medicare |
$689.64
|
| Rate for Payer: Cash Price |
$1,067.30
|
| Rate for Payer: Cash Price |
$1,067.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,510.64
|
| Rate for Payer: Devoted Health Medicare |
$689.64
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$689.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,395.70
|
| Rate for Payer: Humana Medicare |
$689.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,477.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$837.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$689.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,592.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$689.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$689.64
|
| Rate for Payer: University Health Alliance Commercial |
$591.56
|
|
|
CT HEAD BRAIN WO CON
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
424704500
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$1,521.93 |
| Rate for Payer: AlohaCare Medicaid |
$784.50
|
| Rate for Payer: AlohaCare Medicare |
$658.98
|
| Rate for Payer: Cash Price |
$1,019.85
|
| Rate for Payer: Cash Price |
$1,019.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,443.48
|
| Rate for Payer: Devoted Health Medicare |
$658.98
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$139.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$658.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$1,333.65
|
| Rate for Payer: Humana Medicare |
$658.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,412.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$800.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$658.98
|
| Rate for Payer: MDX Hawaii PPO |
$1,521.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$658.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$658.98
|
| Rate for Payer: University Health Alliance Commercial |
$465.11
|
|
|
CT HEAD BRAIN WO CON
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
HCPCS 70450
|
| Hospital Charge Code |
424704500
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,333.65 |
| Max. Negotiated Rate |
$1,521.93 |
| Rate for Payer: Cash Price |
$1,019.85
|
| Rate for Payer: Health Management Network Commercial |
$1,333.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,412.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,521.93
|
|
|
CT HEAD BRAIN WO W CON FS
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
424704700
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,507.50 |
| Max. Negotiated Rate |
$2,861.50 |
| Rate for Payer: Cash Price |
$1,917.50
|
| Rate for Payer: Health Management Network Commercial |
$2,507.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,655.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,861.50
|
|
|
CT HEAD BRAIN WO W CON FS
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
HCPCS 70470
|
| Hospital Charge Code |
424704700
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$2,861.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,475.00
|
| Rate for Payer: AlohaCare Medicare |
$1,239.00
|
| Rate for Payer: Cash Price |
$1,917.50
|
| Rate for Payer: Cash Price |
$1,917.50
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2,714.00
|
| Rate for Payer: Devoted Health Medicare |
$1,239.00
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$232.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,239.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$2,507.50
|
| Rate for Payer: Humana Medicare |
$1,239.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,655.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,504.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,239.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,861.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,239.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,239.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,239.00
|
| Rate for Payer: University Health Alliance Commercial |
$718.67
|
|
|
CT LIM OR LOC F U STUDY
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
424763800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
|
|
CT LIM OR LOC F U STUDY
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
424763800
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$102.81 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: AlohaCare Medicaid |
$296.00
|
| Rate for Payer: AlohaCare Medicare |
$248.64
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Cash Price |
$384.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$544.64
|
| Rate for Payer: Devoted Health Medicare |
$248.64
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$115.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$503.20
|
| Rate for Payer: Humana Medicare |
$248.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$301.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$248.64
|
| Rate for Payer: MDX Hawaii PPO |
$574.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$248.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$115.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.64
|
| Rate for Payer: University Health Alliance Commercial |
$297.96
|
|
|
CT LOW XTR W CON
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
424737010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Health Management Network Commercial |
$1,404.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,486.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,602.44
|
|
|
CT LOW XTR W CON
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
424737010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$194.84 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: AlohaCare Medicaid |
$826.00
|
| Rate for Payer: AlohaCare Medicare |
$693.84
|
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,519.84
|
| Rate for Payer: Devoted Health Medicare |
$693.84
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$194.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$693.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,404.20
|
| Rate for Payer: Humana Medicare |
$693.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,486.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$842.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$693.84
|
| Rate for Payer: MDX Hawaii PPO |
$1,602.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$693.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$693.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$194.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$693.84
|
| Rate for Payer: University Health Alliance Commercial |
$662.37
|
|
|
CT LOW XTR W CON
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
424732010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Health Management Network Commercial |
$1,404.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,486.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,602.44
|
|
|
CT LOW XTR W CON
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
HCPCS 73701
|
| Hospital Charge Code |
424732010
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$194.84 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: AlohaCare Medicaid |
$826.00
|
| Rate for Payer: AlohaCare Medicare |
$693.84
|
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,519.84
|
| Rate for Payer: Devoted Health Medicare |
$693.84
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$194.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$693.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,404.20
|
| Rate for Payer: Humana Medicare |
$693.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,486.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$842.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$693.84
|
| Rate for Payer: MDX Hawaii PPO |
$1,602.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$693.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$693.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$194.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$693.84
|
| Rate for Payer: University Health Alliance Commercial |
$662.37
|
|
|
CT LOW XTR WO CON
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
424737000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$1,181.46 |
| Rate for Payer: AlohaCare Medicaid |
$609.00
|
| Rate for Payer: AlohaCare Medicare |
$511.56
|
| Rate for Payer: Cash Price |
$791.70
|
| Rate for Payer: Cash Price |
$791.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,120.56
|
| Rate for Payer: Devoted Health Medicare |
$511.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$163.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$511.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Humana Medicare |
$511.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,096.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$621.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$511.56
|
| Rate for Payer: MDX Hawaii PPO |
$1,181.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$511.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$511.56
|
| Rate for Payer: University Health Alliance Commercial |
$497.32
|
|
|
CT LOW XTR WO CON
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
HCPCS 73700
|
| Hospital Charge Code |
424737000
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.30 |
| Max. Negotiated Rate |
$1,181.46 |
| Rate for Payer: Cash Price |
$791.70
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,096.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,181.46
|
|
|
CT LOW XTR WO W CON FS
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
424737020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$1,907.02 |
| Rate for Payer: AlohaCare Medicaid |
$983.00
|
| Rate for Payer: AlohaCare Medicare |
$825.72
|
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,808.72
|
| Rate for Payer: Devoted Health Medicare |
$825.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$244.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$825.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,671.10
|
| Rate for Payer: Humana Medicare |
$825.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,002.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$825.72
|
| Rate for Payer: MDX Hawaii PPO |
$1,907.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$825.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$825.72
|
| Rate for Payer: University Health Alliance Commercial |
$786.23
|
|
|
CT LOW XTR WO W CON FS
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
424732020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,671.10 |
| Max. Negotiated Rate |
$1,907.02 |
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Health Management Network Commercial |
$1,671.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,769.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,907.02
|
|
|
CT LOW XTR WO W CON FS
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
424732020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$1,907.02 |
| Rate for Payer: AlohaCare Medicaid |
$983.00
|
| Rate for Payer: AlohaCare Medicare |
$825.72
|
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,808.72
|
| Rate for Payer: Devoted Health Medicare |
$825.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$244.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$825.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,671.10
|
| Rate for Payer: Humana Medicare |
$825.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,002.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$825.72
|
| Rate for Payer: MDX Hawaii PPO |
$1,907.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$825.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$825.72
|
| Rate for Payer: University Health Alliance Commercial |
$786.23
|
|
|
CT LOW XTR WO W CON FS
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 73702
|
| Hospital Charge Code |
424737020
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,671.10 |
| Max. Negotiated Rate |
$1,907.02 |
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Health Management Network Commercial |
$1,671.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,769.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,907.02
|
|
|
CT LUMBAR SPINE W CON
|
Facility
|
OP
|
$2,686.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
424721320
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$232.90 |
| Max. Negotiated Rate |
$2,605.42 |
| Rate for Payer: AlohaCare Medicaid |
$1,343.00
|
| Rate for Payer: AlohaCare Medicare |
$1,128.12
|
| Rate for Payer: Cash Price |
$1,745.90
|
| Rate for Payer: Cash Price |
$1,745.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2,471.12
|
| Rate for Payer: Devoted Health Medicare |
$1,128.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$232.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,128.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$2,283.10
|
| Rate for Payer: Humana Medicare |
$1,128.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,417.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,369.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,128.12
|
| Rate for Payer: MDX Hawaii PPO |
$2,605.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,128.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,128.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$232.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,128.12
|
| Rate for Payer: University Health Alliance Commercial |
$683.96
|
|
|
CT LUMBAR SPINE W CON
|
Facility
|
IP
|
$2,686.00
|
|
|
Service Code
|
HCPCS 72132
|
| Hospital Charge Code |
424721320
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,283.10 |
| Max. Negotiated Rate |
$2,605.42 |
| Rate for Payer: Cash Price |
$1,745.90
|
| Rate for Payer: Health Management Network Commercial |
$2,283.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,417.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,605.42
|
|
|
CT LUMBAR SPINE WO CON
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
424721310
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$1,181.46 |
| Rate for Payer: AlohaCare Medicaid |
$609.00
|
| Rate for Payer: AlohaCare Medicare |
$511.56
|
| Rate for Payer: Cash Price |
$791.70
|
| Rate for Payer: Cash Price |
$791.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,120.56
|
| Rate for Payer: Devoted Health Medicare |
$511.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$177.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$511.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Humana Medicare |
$511.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,096.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$621.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$511.56
|
| Rate for Payer: MDX Hawaii PPO |
$1,181.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$511.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$511.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$177.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$511.56
|
| Rate for Payer: University Health Alliance Commercial |
$502.27
|
|
|
CT LUMBAR SPINE WO CON
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
HCPCS 72131
|
| Hospital Charge Code |
424721310
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,035.30 |
| Max. Negotiated Rate |
$1,181.46 |
| Rate for Payer: Cash Price |
$791.70
|
| Rate for Payer: Health Management Network Commercial |
$1,035.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,096.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,181.46
|
|
|
CT LUMBAR SPINE WO W CON
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
424721330
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,671.10 |
| Max. Negotiated Rate |
$1,907.02 |
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Health Management Network Commercial |
$1,671.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,769.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,907.02
|
|
|
CT LUMBAR SPINE WO W CON
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 72133
|
| Hospital Charge Code |
424721330
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$1,907.02 |
| Rate for Payer: AlohaCare Medicaid |
$983.00
|
| Rate for Payer: AlohaCare Medicare |
$825.72
|
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Cash Price |
$1,277.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,808.72
|
| Rate for Payer: Devoted Health Medicare |
$825.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$291.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$825.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,671.10
|
| Rate for Payer: Humana Medicare |
$825.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,002.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$825.72
|
| Rate for Payer: MDX Hawaii PPO |
$1,907.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$825.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$291.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$825.72
|
| Rate for Payer: University Health Alliance Commercial |
$789.62
|
|
|
CT MAX FAC W CON
|
Facility
|
OP
|
$1,652.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
424704870
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: AlohaCare Medicaid |
$826.00
|
| Rate for Payer: AlohaCare Medicare |
$693.84
|
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,519.84
|
| Rate for Payer: Devoted Health Medicare |
$693.84
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$186.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$693.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,404.20
|
| Rate for Payer: Humana Medicare |
$693.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,486.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$842.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$693.84
|
| Rate for Payer: MDX Hawaii PPO |
$1,602.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$693.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$693.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$186.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$693.84
|
| Rate for Payer: University Health Alliance Commercial |
$678.04
|
|
|
CT MAX FAC W CON
|
Facility
|
IP
|
$1,652.00
|
|
|
Service Code
|
HCPCS 70487
|
| Hospital Charge Code |
424704870
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,404.20 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: Cash Price |
$1,073.80
|
| Rate for Payer: Health Management Network Commercial |
$1,404.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,486.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,602.44
|
|
