|
HC INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
7614270001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.33 |
| Max. Negotiated Rate |
$896.28 |
| 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 Commercial |
$302.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.44
|
| 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 |
$471.24
|
| 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 Medicaid |
$82.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.44
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
7614270001
|
|
Hospital Revenue Code
|
761
|
| 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 INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
7615470001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,929.20 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,336.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
7615470001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: AlohaCare Medicaid |
$4,076.00
|
| Rate for Payer: AlohaCare Medicare |
$2,527.12
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Devoted Health Medicare |
$2,771.68
|
| 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 |
$2,527.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,744.40
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: Humana Medicare |
$2,527.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,336.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,527.12
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,527.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,527.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,527.12
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
HCPCS 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,207.90 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,396.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
HCPCS 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,887.00
|
| Rate for Payer: AlohaCare Medicare |
$1,169.94
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Devoted Health Medicare |
$1,283.16
|
| 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 |
$1,169.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,585.30
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Humana Medicare |
$1,169.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,396.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,169.94
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,169.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,169.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,169.94
|
| Rate for Payer: University Health Alliance Commercial |
$2,750.87
|
|
|
HC INCISION AND DRAINAGE, BURSA, FOOT
|
Facility
|
OP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 28001
|
| Hospital Charge Code |
4502800101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: AlohaCare Medicaid |
$3,157.00
|
| Rate for Payer: AlohaCare Medicare |
$1,957.34
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Devoted Health Medicare |
$2,146.76
|
| 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 |
$1,957.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,998.30
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: Humana Medicare |
$1,957.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,682.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,957.34
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,957.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,957.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,957.34
|
| Rate for Payer: University Health Alliance Commercial |
$4,602.27
|
|
|
HC INCISION AND DRAINAGE, BURSA, FOOT
|
Facility
|
IP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 28001
|
| Hospital Charge Code |
4502800101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,366.90 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,682.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, FOREARM AND/OR WRIST
|
Facility
|
IP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
4502502801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,975.20 |
| Max. Negotiated Rate |
$12,524.64 |
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Health Management Network Commercial |
$10,975.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,620.80
|
| Rate for Payer: MDX Hawaii PPO |
$12,524.64
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, FOREARM AND/OR WRIST
|
Facility
|
OP
|
$12,912.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
4502502801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,524.64 |
| Rate for Payer: AlohaCare Medicaid |
$6,456.00
|
| Rate for Payer: AlohaCare Medicare |
$4,002.72
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Cash Price |
$7,747.20
|
| Rate for Payer: Devoted Health Medicare |
$4,390.08
|
| 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 |
$4,002.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,266.40
|
| Rate for Payer: Health Management Network Commercial |
$10,975.20
|
| Rate for Payer: Humana Medicare |
$4,002.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,620.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,002.72
|
| Rate for Payer: MDX Hawaii PPO |
$12,524.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,002.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,002.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,002.72
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SHOULDER AREA
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
4502303001
|
|
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 |
$4,035.20
|
|
|
HC INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SHOULDER AREA
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
4502303001
|
|
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 INCISION AND DRAINAGE, INFECTED BURSA, FOREARM AND/OR WRIST
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
4502503101
|
|
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 INCISION AND DRAINAGE, INFECTED BURSA, FOREARM AND/OR WRIST
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 25031
|
| Hospital Charge Code |
4502503101
|
|
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 |
$5,160.40
|
|
|
HC INCISION AND DRAINAGE OF RECTAL ABSCESS
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
4504500501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,346.00
|
| Rate for Payer: AlohaCare Medicare |
$1,454.52
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Devoted Health Medicare |
$1,595.28
|
| 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 |
$1,454.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,457.40
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Humana Medicare |
$1,454.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,222.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,454.52
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,454.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,454.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,454.52
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INCISION AND DRAINAGE OF RECTAL ABSCESS
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45005
|
| Hospital Charge Code |
4504500501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,988.20 |
| Max. Negotiated Rate |
$4,551.24 |
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,222.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
|
|
HC INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
4502393001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,480.05 |
| Max. Negotiated Rate |
$10,818.41 |
| Rate for Payer: Cash Price |
$6,691.80
|
| Rate for Payer: Health Management Network Commercial |
$9,480.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,037.70
|
| Rate for Payer: MDX Hawaii PPO |
$10,818.41
|
|
|
HC INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23930
|
| Hospital Charge Code |
4502393001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,818.41 |
| Rate for Payer: AlohaCare Medicaid |
$5,576.50
|
| Rate for Payer: AlohaCare Medicare |
$3,457.43
|
| Rate for Payer: Cash Price |
$6,691.80
|
| Rate for Payer: Cash Price |
$6,691.80
|
| Rate for Payer: Devoted Health Medicare |
$3,792.02
|
| 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 |
$3,457.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,595.35
|
| Rate for Payer: Health Management Network Commercial |
$9,480.05
|
| Rate for Payer: Humana Medicare |
$3,457.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,037.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,457.43
|
| Rate for Payer: MDX Hawaii PPO |
$10,818.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,457.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,457.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,457.43
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC INFLUENZA A&B RT AMP PROBE
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
|
|
HC INFLUENZA A&B RT AMP PROBE
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: AlohaCare Medicaid |
$402.00
|
| Rate for Payer: AlohaCare Medicare |
$249.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Devoted Health Medicare |
$273.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Humana Medicare |
$249.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$249.24
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$249.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.24
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
HC INFLUENZA ID POCT
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: AlohaCare Medicaid |
$402.00
|
| Rate for Payer: AlohaCare Medicare |
$249.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Devoted Health Medicare |
$273.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Humana Medicare |
$249.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$249.24
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$249.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.24
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
HC INFLUENZA ID POCT
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
3068750202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$779.88 |
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Health Management Network Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$723.60
|
| Rate for Payer: MDX Hawaii PPO |
$779.88
|
|
|
HC INITIAL RX BURN(S) 1ST DEGREE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
7611600001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$245.21
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$268.94
|
| 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 |
$245.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$245.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.21
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.21
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC INITIAL RX BURN(S) 1ST DEGREE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
7611600001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC INJ,ANES AGENT,BRACHIAL PLEXUS,SINGLE
|
Facility
|
OP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
3616441501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: AlohaCare Medicaid |
$1,771.50
|
| Rate for Payer: AlohaCare Medicare |
$1,098.33
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Devoted Health Medicare |
$1,204.62
|
| 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 |
$1,098.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,365.85
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: Humana Medicare |
$1,098.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,188.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,098.33
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,098.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,098.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,098.33
|
| Rate for Payer: University Health Alliance Commercial |
$2,582.49
|
|
