|
HC CLOSED RX TRIMALLEOLAR FX,MANIP
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
4502781801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| 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 Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,974.39
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC CLOSED RX ULNA SHAFT FX
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
7612553001
|
|
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 ULNA SHAFT FX
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
7612553001
|
|
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 ULNA SHAFT FX,MANIPULATN
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
7612553501
|
|
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 ULNA SHAFT FX,MANIPULATN
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
7612553501
|
|
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 ULNA STYLOID FX
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
7612565001
|
|
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 ULNA STYLOID FX
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
7612565001
|
|
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 WEIGHT BEAR DIST TIB,MANIP
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
7612782501
|
|
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 WEIGHT BEAR DIST TIB,MANIP
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
7612782501
|
|
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 Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,974.39
|
| Rate for Payer: University Health Alliance Commercial |
$4,642.36
|
|
|
HC CLOSED TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
4502722201
|
|
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 TREATMENT OF ACETABULUM (HIP SOCKET) FRACTURE(S); WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
4502722201
|
|
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 TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
4502354501
|
|
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 TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITH MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
4502354501
|
|
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 TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 23540
|
| Hospital Charge Code |
4502354001
|
|
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 TREATMENT OF ACROMIOCLAVICULAR DISLOCATION; WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 23540
|
| Hospital Charge Code |
4502354001
|
|
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 TREATMENT OF BIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
4502784201
|
|
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 Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,974.39
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
4502784201
|
|
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 TREATMENT OF BIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27831
|
| Hospital Charge Code |
4502783101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,746.55 |
| Max. Negotiated Rate |
$12,263.71 |
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Health Management Network Commercial |
$10,746.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,378.70
|
| Rate for Payer: MDX Hawaii PPO |
$12,263.71
|
|
|
HC CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27831
|
| Hospital Charge Code |
4502783101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$12,263.71 |
| Rate for Payer: AlohaCare Medicaid |
$6,321.50
|
| Rate for Payer: AlohaCare Medicare |
$3,919.33
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Devoted Health Medicare |
$4,298.62
|
| 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 |
$3,919.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,010.85
|
| Rate for Payer: Health Management Network Commercial |
$10,746.55
|
| Rate for Payer: Humana Medicare |
$3,919.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,378.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,919.33
|
| Rate for Payer: MDX Hawaii PPO |
$12,263.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,919.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,919.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,919.33
|
| Rate for Payer: University Health Alliance Commercial |
$9,215.48
|
|
|
HC CLOSED TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 28405
|
| Hospital Charge Code |
4502840501
|
|
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 TREATMENT OF CALCANEAL FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 28405
|
| Hospital Charge Code |
4502840501
|
|
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 TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
4502840001
|
|
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 TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
4502840001
|
|
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 TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
4502350001
|
|
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 TREATMENT OF CLAVICULAR FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
4502350001
|
|
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
|
|
