|
HC CLOSED TREATMENT OF COCCYGEAL FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
4502720001
|
|
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 COCCYGEAL FRACTURE; WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27200
|
| Hospital Charge Code |
4502720001
|
|
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 DISTAL FEMORAL EPIPHYSEAL SEPARATION, WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27516
|
| Hospital Charge Code |
4502751601
|
|
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 DISTAL FEMORAL EPIPHYSEAL SEPARATION, WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27516
|
| Hospital Charge Code |
4502751601
|
|
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 DISTAL FEMORAL FRACTURE, MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
4502750801
|
|
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 DISTAL FEMORAL FRACTURE, MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
4502750801
|
|
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 DISTAL FIBULA FRACTURE (E.G., LATERAL MALLEOLUS); WITHOUT MANIPULATION
|
Facility
|
IP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27781
|
| Hospital Charge Code |
4502778101
|
|
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 DISTAL FIBULA FRACTURE (E.G., LATERAL MALLEOLUS); WITHOUT MANIPULATION
|
Facility
|
OP
|
$6,369.00
|
|
|
Service Code
|
HCPCS 27781
|
| Hospital Charge Code |
4502778101
|
|
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 |
$4,642.36
|
|
|
HC CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (E.G., COLLES OR SMITH TYPE); WITH MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25660
|
| Hospital Charge Code |
4502566001
|
|
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 DISTAL RADIAL FRACTURE (E.G., COLLES OR SMITH TYPE); WITH MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25660
|
| Hospital Charge Code |
4502566001
|
|
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 DISTAL RADIAL FRACTURE (E.G., COLLES OR SMITH TYPE); WITHOUT MANIPULATION
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
4502562201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.08 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$484.00
|
| Rate for Payer: AlohaCare Medicare |
$300.08
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Devoted Health Medicare |
$329.12
|
| 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 |
$300.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$919.60
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Humana Medicare |
$300.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.08
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$300.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.08
|
| Rate for Payer: University Health Alliance Commercial |
$705.58
|
|
|
HC CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (E.G., COLLES OR SMITH TYPE); WITHOUT MANIPULATION
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
4502562201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$822.80 |
| Max. Negotiated Rate |
$938.96 |
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.20
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
|
|
HC CLOSED TREATMENT OF FEMORAL HEAD FRACTURE, WITH MANIPULATION
|
Facility
|
IP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
4502726701
|
|
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 FEMORAL HEAD FRACTURE, WITH MANIPULATION
|
Facility
|
OP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
4502726701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,919.33
|
| Rate for Payer: University Health Alliance Commercial |
$9,215.48
|
|
|
HC CLOSED TREATMENT OF FEMORAL HEAD FRACTURE, WITHOUT MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
4502726801
|
|
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 FEMORAL HEAD FRACTURE, WITHOUT MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
4502726801
|
|
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 Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.85
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF FEMORAL NECK FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27232
|
| Hospital Charge Code |
4502723201
|
|
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 Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.85
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED TREATMENT OF FEMORAL NECK FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27232
|
| Hospital Charge Code |
4502723201
|
|
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 FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
4502750001
|
|
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 FEMORAL SHAFT FRACTURE, WITHOUT MANIPULATION
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
4502750001
|
|
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 FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT MANIPULATION
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 21400
|
| Hospital Charge Code |
4502140001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$992.00
|
| Rate for Payer: AlohaCare Medicare |
$615.04
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Devoted Health Medicare |
$674.56
|
| 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 |
$615.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,884.80
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Humana Medicare |
$615.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$615.04
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$615.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$615.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$615.04
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT MANIPULATION
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 21400
|
| Hospital Charge Code |
4502140001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,686.40 |
| Max. Negotiated Rate |
$1,924.48 |
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Health Management Network Commercial |
$1,686.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,785.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,924.48
|
|
|
HC CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
4502362501
|
|
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 CLOSED TREATMENT OF GREATER HUMERAL TUBEROSITY FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
4502362501
|
|
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 CLOSED TREATMENT OF GREATER TROCHANTERIC FRACTURE; WITH MANIPULATION
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
4502724001
|
|
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
|
|
