|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.03 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$159.03
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$174.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$159.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.03
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
7504660801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,446.41 |
| Rate for Payer: AlohaCare Medicaid |
$1,776.50
|
| Rate for Payer: AlohaCare Medicare |
$1,101.43
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Devoted Health Medicare |
$1,208.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,101.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,375.35
|
| Rate for Payer: Health Management Network Commercial |
$3,020.05
|
| Rate for Payer: Humana Medicare |
$1,101.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,197.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,101.43
|
| Rate for Payer: MDX Hawaii PPO |
$3,446.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,101.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,101.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,101.43
|
| Rate for Payer: University Health Alliance Commercial |
$2,589.78
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
IP
|
$3,553.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
7504660801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,020.05 |
| Max. Negotiated Rate |
$3,446.41 |
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Health Management Network Commercial |
$3,020.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,197.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,446.41
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - Susceptibility Charge
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$19.53
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$21.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.48
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$19.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.53
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.53
|
| Rate for Payer: University Health Alliance Commercial |
$17.82
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - Susceptibility Charge
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718604
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718604
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$24.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$22.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.63
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.63
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE SO
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$24.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$22.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.63
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.63
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE SO
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$34.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$31.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.31
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.31
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
3028603902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$47.00
|
| Rate for Payer: AlohaCare Medicare |
$29.14
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$31.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.16
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$29.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.14
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.14
|
| Rate for Payer: University Health Alliance Commercial |
$28.86
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
3028603902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
HC APP FINGER SPLINT DYNM
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4202913101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$73.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$80.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$73.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.16
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC APP FINGER SPLINT DYNM
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4202913101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 20660
|
| Hospital Charge Code |
4502066001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,300.60 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
|
|
HC APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 20660
|
| Hospital Charge Code |
4502066001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: AlohaCare Medicaid |
$3,118.00
|
| Rate for Payer: AlohaCare Medicare |
$1,933.16
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Devoted Health Medicare |
$2,120.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,933.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,924.20
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Humana Medicare |
$1,933.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,933.16
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,933.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,933.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,933.16
|
| Rate for Payer: University Health Alliance Commercial |
$4,545.42
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.68 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$314.00
|
| Rate for Payer: AlohaCare Medicare |
$194.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$213.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$194.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.68
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.68
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND); STATIC
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
4502908601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.65 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$307.50
|
| Rate for Payer: AlohaCare Medicare |
$190.65
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Devoted Health Medicare |
$209.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$584.25
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Humana Medicare |
$190.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.65
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.65
|
| Rate for Payer: University Health Alliance Commercial |
$448.27
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND); STATIC
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
4502908601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.75 |
| Max. Negotiated Rate |
$596.55 |
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.50
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7002913001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$589.05 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.70
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7002913001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: AlohaCare Medicaid |
$346.50
|
| Rate for Payer: AlohaCare Medicare |
$214.83
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$658.35
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: Humana Medicare |
$214.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$623.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$353.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.83
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.83
|
| Rate for Payer: University Health Alliance Commercial |
$505.13
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$898.45 |
| Max. Negotiated Rate |
$1,025.29 |
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
|
|
HC APPLY FOREARM CAST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
7002907501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.67 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$528.50
|
| Rate for Payer: AlohaCare Medicare |
$327.67
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Devoted Health Medicare |
$359.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$327.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,004.15
|
| Rate for Payer: Health Management Network Commercial |
$898.45
|
| Rate for Payer: Humana Medicare |
$327.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$951.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$327.67
|
| Rate for Payer: MDX Hawaii PPO |
$1,025.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$327.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$327.67
|
| Rate for Payer: University Health Alliance Commercial |
$770.45
|
|
