|
HC C DIFF AMP PROBE/CDT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
|
|
HC C DIFF AMP PROBE/TCDB
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: AlohaCare Medicaid |
$156.50
|
| Rate for Payer: AlohaCare Medicare |
$97.03
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$106.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.27
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Humana Medicare |
$97.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.03
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.03
|
| Rate for Payer: University Health Alliance Commercial |
$93.00
|
|
|
HC C DIFF AMP PROBE/TCDB
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
4505171001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,576.32 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.00
|
| Rate for Payer: AlohaCare Medicare |
$823.36
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Devoted Health Medicare |
$903.04
|
| 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 |
$823.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,523.20
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Humana Medicare |
$823.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,390.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$823.36
|
| Rate for Payer: MDX Hawaii PPO |
$2,576.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$823.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$823.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$823.36
|
| Rate for Payer: University Health Alliance Commercial |
$1,935.96
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
IP
|
$2,656.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
4505171001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,257.60 |
| Max. Negotiated Rate |
$2,576.32 |
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,390.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,576.32
|
|
|
HC CHG COLLECTION VENOUS BLOOD, VENIPUNCTURE - DRAW CHARGE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: AlohaCare Medicaid |
$38.00
|
| Rate for Payer: AlohaCare Medicare |
$23.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Devoted Health Medicare |
$25.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.20
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Humana Medicare |
$23.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.56
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.56
|
| Rate for Payer: University Health Alliance Commercial |
$55.40
|
|
|
HC CHG COLLECTION VENOUS BLOOD, VENIPUNCTURE - DRAW CHARGE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
|
|
HC CHG US, RETROPERITNL ABD, LTD - CV US ABDOMINAL AORTA LIMITED
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4027677503
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC CHG US, RETROPERITNL ABD, LTD - CV US ABDOMINAL AORTA LIMITED
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
4027677503
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$202.63
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| 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 |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| 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 |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.53
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUAL SERUM
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| 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 |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| 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 |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.53
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUAL SERUM
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470302
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$42.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$39.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.06
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.06
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA AMP PROBE
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA AMP PROBE
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$91.14
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$99.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$91.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.14
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC CLOSED RX ACETABULAR FX
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
7612722001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
HC CLOSED RX ACETABULAR FX
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
7612722001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.85 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$289.85
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$317.90
|
| 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 |
$289.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$289.85
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.85
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED RX ANKLE DISLOCATN
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
7612784001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.05 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$477.50
|
| Rate for Payer: AlohaCare Medicare |
$296.05
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Devoted Health Medicare |
$324.70
|
| 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 |
$296.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$907.25
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Humana Medicare |
$296.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$296.05
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.05
|
| Rate for Payer: University Health Alliance Commercial |
$696.10
|
|
|
HC CLOSED RX ANKLE DISLOCATN
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
7612784001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$811.75 |
| Max. Negotiated Rate |
$926.35 |
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Health Management Network Commercial |
$811.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$859.50
|
| Rate for Payer: MDX Hawaii PPO |
$926.35
|
|
|
HC CLOSED RX CARPAL FX,MAIPULATN
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
7612563501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,184.50
|
| Rate for Payer: AlohaCare Medicare |
$1,974.39
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Devoted Health Medicare |
$2,165.46
|
| 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 |
$1,974.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,050.55
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Humana Medicare |
$1,974.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,974.39
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,974.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,974.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,974.39
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED RX CARPAL FX,MAIPULATN
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
7612563501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,413.65 |
| Max. Negotiated Rate |
$6,177.93 |
| Rate for Payer: Cash Price |
$3,821.40
|
| Rate for Payer: Health Management Network Commercial |
$5,413.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,732.10
|
| Rate for Payer: MDX Hawaii PPO |
$6,177.93
|
|
|
HC CLOSED RX CLAVICLE FX,MANIPULATN
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
7612350501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,933.16
|
| Rate for Payer: University Health Alliance Commercial |
$4,545.42
|
|
|
HC CLOSED RX CLAVICLE FX,MANIPULATN
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
7612350501
|
|
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
|
|
