|
HC CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40831
|
| Hospital Charge Code |
4504083101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,924.48 |
| 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 |
$1,446.14
|
|
|
HC CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
4501202101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$492.90
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$540.60
|
| 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 |
$492.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$492.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
4501202101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| 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 |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| 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 |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.31
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
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 COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: AlohaCare Medicaid |
$32.50
|
| Rate for Payer: AlohaCare Medicare |
$20.15
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$22.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Humana Medicare |
$20.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.15
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.15
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.50
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.60
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: AlohaCare Medicaid |
$27.00
|
| Rate for Payer: AlohaCare Medicare |
$16.74
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$18.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Humana Medicare |
$16.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.74
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.74
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,681.50 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,251.00
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: AlohaCare Medicaid |
$5,695.00
|
| Rate for Payer: AlohaCare Medicare |
$3,530.90
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Devoted Health Medicare |
$3,872.60
|
| 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 |
$3,530.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,820.50
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Humana Medicare |
$3,530.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,251.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,530.90
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,530.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,530.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,530.90
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC CONCENTRATION INF AGNT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$17.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$19.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.68
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$17.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.36
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.36
|
| Rate for Payer: University Health Alliance Commercial |
$17.26
|
|
|
HC CONCENTRATION INF AGNT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
HC CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$462.00
|
| Rate for Payer: AlohaCare Medicare |
$286.44
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$314.16
|
| 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 |
$286.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$286.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.44
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.44
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$13.33
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$14.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$13.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.33
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.33
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC C-REACTIVE PROTEIN HIGH SENSITIVITY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$33.79
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$37.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.95
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$33.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.79
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.79
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HC C-REACTIVE PROTEIN HIGH SENSITIVITY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HC CRITICAL CARE, E/M 30-74 MINUTES
|
Facility
|
OP
|
$6,883.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
4509929101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,676.51 |
| Rate for Payer: AlohaCare Medicaid |
$3,441.50
|
| Rate for Payer: AlohaCare Medicare |
$2,133.73
|
| Rate for Payer: Cash Price |
$4,129.80
|
| Rate for Payer: Cash Price |
$4,129.80
|
| Rate for Payer: Devoted Health Medicare |
$2,340.22
|
| 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 |
$2,133.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,538.85
|
| Rate for Payer: Health Management Network Commercial |
$5,850.55
|
| Rate for Payer: Humana Medicare |
$2,133.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,194.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,133.73
|
| Rate for Payer: MDX Hawaii PPO |
$6,676.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,133.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,133.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,133.73
|
| Rate for Payer: University Health Alliance Commercial |
$5,017.02
|
|
|
HC CRITICAL CARE, E/M 30-74 MINUTES
|
Facility
|
IP
|
$6,883.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
4509929101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,850.55 |
| Max. Negotiated Rate |
$6,676.51 |
| Rate for Payer: Cash Price |
$4,129.80
|
| Rate for Payer: Health Management Network Commercial |
$5,850.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,194.70
|
| Rate for Payer: MDX Hawaii PPO |
$6,676.51
|
|
|
HC CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
7613090301
|
|
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 CTRL NOSEBLEED,ANTER,COMPLEX
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
7613090301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
7613090101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$497.61 |
| 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 Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.03
|
| 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 |
$261.63
|
| 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 Medicaid |
$44.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC CTRL NOSEBLEED,ANTER,SIMPLE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
7613090101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
