|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
7611104501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.15 |
| Max. Negotiated Rate |
$1,007.83 |
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Health Management Network Commercial |
$883.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,007.83
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
HCPCS 11045
|
| Hospital Charge Code |
7611104501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.09 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$519.50
|
| Rate for Payer: AlohaCare Medicare |
$322.09
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Devoted Health Medicare |
$353.26
|
| 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 |
$322.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$987.05
|
| Rate for Payer: Health Management Network Commercial |
$883.15
|
| Rate for Payer: Humana Medicare |
$322.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$935.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$322.09
|
| Rate for Payer: MDX Hawaii PPO |
$1,007.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$322.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$322.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$322.09
|
| Rate for Payer: University Health Alliance Commercial |
$757.33
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7611104301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,218.00
|
| Rate for Payer: AlohaCare Medicare |
$755.16
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$828.24
|
| 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 |
$755.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$755.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$755.16
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$755.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$755.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$755.16
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
7611104301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,192.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
7611104401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$3,224.00
|
| Rate for Payer: AlohaCare Medicare |
$1,998.88
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$2,192.32
|
| 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 |
$1,998.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,125.60
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$1,998.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,998.88
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,998.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,998.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,998.88
|
| Rate for Payer: University Health Alliance Commercial |
$4,699.95
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
7611104401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$2,374.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
7611104701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,302.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,187.00
|
| Rate for Payer: AlohaCare Medicare |
$735.94
|
| Rate for Payer: Cash Price |
$1,424.40
|
| Rate for Payer: Cash Price |
$1,424.40
|
| Rate for Payer: Devoted Health Medicare |
$807.16
|
| 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 |
$735.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,255.30
|
| Rate for Payer: Health Management Network Commercial |
$2,017.90
|
| Rate for Payer: Humana Medicare |
$735.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,136.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$735.94
|
| Rate for Payer: MDX Hawaii PPO |
$2,302.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$735.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$735.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$735.94
|
| Rate for Payer: University Health Alliance Commercial |
$1,730.41
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$2,374.00
|
|
|
Service Code
|
HCPCS 11047
|
| Hospital Charge Code |
7611104701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,017.90 |
| Max. Negotiated Rate |
$2,302.78 |
| Rate for Payer: Cash Price |
$1,424.40
|
| Rate for Payer: Health Management Network Commercial |
$2,017.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,136.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,302.78
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
7611104601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,017.45 |
| Max. Negotiated Rate |
$1,161.09 |
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Health Management Network Commercial |
$1,017.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,077.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,161.09
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 11046
|
| Hospital Charge Code |
7611104601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$371.07 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$598.50
|
| Rate for Payer: AlohaCare Medicare |
$371.07
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Cash Price |
$718.20
|
| Rate for Payer: Devoted Health Medicare |
$406.98
|
| 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 |
$371.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,137.15
|
| Rate for Payer: Health Management Network Commercial |
$1,017.45
|
| Rate for Payer: Humana Medicare |
$371.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,077.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$371.07
|
| Rate for Payer: MDX Hawaii PPO |
$1,161.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$371.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$371.07
|
| Rate for Payer: University Health Alliance Commercial |
$872.49
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
3068780401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87804
|
| Hospital Charge Code |
3068780401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$43.09
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$47.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.55
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$43.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.09
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.09
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC DILATE ESOPHAGUS - ESOPHAGEAL DILATION
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
7504345001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,105.05 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
|
|
HC DILATE ESOPHAGUS - ESOPHAGEAL DILATION
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43450
|
| Hospital Charge Code |
7504345001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: AlohaCare Medicaid |
$1,826.50
|
| Rate for Payer: AlohaCare Medicare |
$1,132.43
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Devoted Health Medicare |
$1,242.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,132.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,470.35
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Humana Medicare |
$1,132.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,132.43
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,132.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,132.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,132.43
|
| Rate for Payer: University Health Alliance Commercial |
$2,662.67
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$57.50
|
| Rate for Payer: AlohaCare Medicare |
$35.65
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Devoted Health Medicare |
$39.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.74
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$35.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.65
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.65
|
| Rate for Payer: University Health Alliance Commercial |
$35.52
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
|
|
HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
4506902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,520.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,716.00
|
|
|
HC DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
4506902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,400.00
|
| Rate for Payer: AlohaCare Medicare |
$868.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Devoted Health Medicare |
$952.00
|
| 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 |
$868.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,660.00
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: Humana Medicare |
$868.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,520.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$868.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,716.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$868.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$868.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$868.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,040.92
|
|
|
HC DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
4504080101
|
|
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 DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40801
|
| Hospital Charge Code |
4504080101
|
|
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 DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; FLOOR OF MOUTH
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
4504100001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,722.95 |
| Max. Negotiated Rate |
$1,966.19 |
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Health Management Network Commercial |
$1,722.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,824.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,966.19
|
|
|
HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; FLOOR OF MOUTH
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
4504100001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,966.19 |
| Rate for Payer: AlohaCare Medicaid |
$1,013.50
|
| Rate for Payer: AlohaCare Medicare |
$628.37
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Devoted Health Medicare |
$689.18
|
| 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 |
$628.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,925.65
|
| Rate for Payer: Health Management Network Commercial |
$1,722.95
|
| Rate for Payer: Humana Medicare |
$628.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,824.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$628.37
|
| Rate for Payer: MDX Hawaii PPO |
$1,966.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$628.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$628.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$628.37
|
| Rate for Payer: University Health Alliance Commercial |
$1,477.48
|
|
|
HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; SUBMANDIBULAR SPACE
|
Facility
|
OP
|
$12,637.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4504100801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,257.89 |
| Rate for Payer: AlohaCare Medicaid |
$6,318.50
|
| Rate for Payer: AlohaCare Medicare |
$3,917.47
|
| Rate for Payer: Cash Price |
$7,582.20
|
| Rate for Payer: Cash Price |
$7,582.20
|
| Rate for Payer: Devoted Health Medicare |
$4,296.58
|
| 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 |
$3,917.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,005.15
|
| Rate for Payer: Health Management Network Commercial |
$10,741.45
|
| Rate for Payer: Humana Medicare |
$3,917.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,373.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,917.47
|
| Rate for Payer: MDX Hawaii PPO |
$12,257.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,917.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,917.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,917.47
|
| Rate for Payer: University Health Alliance Commercial |
$9,211.11
|
|
|
HC DRAINAGE OF ABSCESS, CYST, OR HEMATOMA, INTRAORAL; SUBMANDIBULAR SPACE
|
Facility
|
IP
|
$12,637.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
4504100801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,741.45 |
| Max. Negotiated Rate |
$12,257.89 |
| Rate for Payer: Cash Price |
$7,582.20
|
| Rate for Payer: Health Management Network Commercial |
$10,741.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,373.30
|
| Rate for Payer: MDX Hawaii PPO |
$12,257.89
|
|
|
HC DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
4504180001
|
|
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
|
|
