|
HC INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL
|
Facility
|
IP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 20650
|
| Hospital Charge Code |
4502065001
|
|
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 INSERT NON-TUNNEL CV CATH
|
Facility
|
IP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
3613655601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,647.10 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,273.40
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
|
|
HC INSERT NON-TUNNEL CV CATH
|
Facility
|
OP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
3613655601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: AlohaCare Medicaid |
$6,263.00
|
| Rate for Payer: AlohaCare Medicare |
$3,883.06
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Devoted Health Medicare |
$4,258.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,032.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,883.06
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Humana Medicare |
$3,883.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,273.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,883.06
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,883.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,883.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,883.06
|
| Rate for Payer: University Health Alliance Commercial |
$9,130.20
|
|
|
HC INSERT NON-TUNNEL CV CATH < 5 Y/O
|
Facility
|
OP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
7613655501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: AlohaCare Medicaid |
$6,263.00
|
| Rate for Payer: AlohaCare Medicare |
$3,883.06
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Devoted Health Medicare |
$4,258.84
|
| 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 |
$3,883.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,899.70
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Humana Medicare |
$3,883.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,273.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,883.06
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,883.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,883.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,883.06
|
| Rate for Payer: University Health Alliance Commercial |
$9,130.20
|
|
|
HC INSERT NON-TUNNEL CV CATH < 5 Y/O
|
Facility
|
IP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36555
|
| Hospital Charge Code |
7613655501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,647.10 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,273.40
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,COMP
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
7615170301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$529.55 |
| Max. Negotiated Rate |
$604.31 |
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$560.70
|
| Rate for Payer: MDX Hawaii PPO |
$604.31
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,COMP
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
7615170301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.13 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$311.50
|
| Rate for Payer: AlohaCare Medicare |
$193.13
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$211.82
|
| 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 |
$193.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$591.85
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Humana Medicare |
$193.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$560.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.13
|
| Rate for Payer: MDX Hawaii PPO |
$604.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$193.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.13
|
| Rate for Payer: University Health Alliance Commercial |
$454.10
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76151702PB
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.90 |
| 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 |
$21.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
3615170201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$2,837.00 |
| 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: 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: 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 |
$2,837.00
|
| 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 |
$21.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
3615170201
|
|
Hospital Revenue Code
|
361
|
| 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 INSERT,TEMP INDWELLING BLAD CATH,SIMPLE
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
76151702PB
|
|
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
|
|
|
HC IN SITU HYBRID EA ADD
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
3108836401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$638.35 |
| Max. Negotiated Rate |
$728.47 |
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Health Management Network Commercial |
$638.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.90
|
| Rate for Payer: MDX Hawaii PPO |
$728.47
|
|
|
HC IN SITU HYBRID EA ADD
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 88364
|
| Hospital Charge Code |
3108836401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$728.47 |
| Rate for Payer: AlohaCare Medicaid |
$375.50
|
| Rate for Payer: AlohaCare Medicare |
$232.81
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Cash Price |
$450.60
|
| Rate for Payer: Devoted Health Medicare |
$255.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$232.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$713.45
|
| Rate for Payer: Health Management Network Commercial |
$638.35
|
| Rate for Payer: Humana Medicare |
$232.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$675.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$383.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$232.81
|
| Rate for Payer: MDX Hawaii PPO |
$728.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$232.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$232.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$232.81
|
| Rate for Payer: University Health Alliance Commercial |
$203.04
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 12.6 TO 20.0 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
4501204501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,362.92 |
| 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 |
$1,775.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 12.6 TO 20.0 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12045
|
| Hospital Charge Code |
4501204501
|
|
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 INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
4501204601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,362.92 |
| 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 Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$755.16
|
| Rate for Payer: University Health Alliance Commercial |
$1,775.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 12046
|
| Hospital Charge Code |
4501204601
|
|
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 INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
OP
|
$7,128.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
4501204701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,914.16 |
| Rate for Payer: AlohaCare Medicaid |
$3,564.00
|
| Rate for Payer: AlohaCare Medicare |
$2,209.68
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Devoted Health Medicare |
$2,423.52
|
| 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 |
$2,209.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,771.60
|
| Rate for Payer: Health Management Network Commercial |
$6,058.80
|
| Rate for Payer: Humana Medicare |
$2,209.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,415.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,209.68
|
| Rate for Payer: MDX Hawaii PPO |
$6,914.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,209.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,209.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,209.68
|
| Rate for Payer: University Health Alliance Commercial |
$5,195.60
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
IP
|
$7,128.00
|
|
|
Service Code
|
HCPCS 12047
|
| Hospital Charge Code |
4501204701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,058.80 |
| Max. Negotiated Rate |
$6,914.16 |
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Health Management Network Commercial |
$6,058.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,415.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,914.16
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, TRUNK, AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
OP
|
$7,280.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
4501203701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,061.60 |
| Rate for Payer: AlohaCare Medicaid |
$3,640.00
|
| Rate for Payer: AlohaCare Medicare |
$2,256.80
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Devoted Health Medicare |
$2,475.20
|
| 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 |
$2,256.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,916.00
|
| Rate for Payer: Health Management Network Commercial |
$6,188.00
|
| Rate for Payer: Humana Medicare |
$2,256.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,552.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,256.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,061.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,256.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,256.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,256.80
|
| Rate for Payer: University Health Alliance Commercial |
$5,306.39
|
|
|
HC INTERMEDIATE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, TRUNK, AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
IP
|
$7,280.00
|
|
|
Service Code
|
HCPCS 12037
|
| Hospital Charge Code |
4501203701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,188.00 |
| Max. Negotiated Rate |
$7,061.60 |
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Health Management Network Commercial |
$6,188.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,552.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,061.60
|
|
|
HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
3018355001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$24.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.74
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$22.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.63
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.63
|
| Rate for Payer: University Health Alliance Commercial |
$22.59
|
|
|
HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
3018355001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
|
HC ISOLATION ROOM DAILY
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
1640000001
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$4,140.84 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$6,253.00
|
| Rate for Payer: Cash Price |
$3,375.00
|
| Rate for Payer: Cash Price |
$3,375.00
|
| Rate for Payer: Devoted Health Medicare |
$7,175.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,140.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6,523.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,140.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$4,781.25
|
| Rate for Payer: Humana Medicare |
$6,523.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,062.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,523.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,456.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,523.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,523.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HC IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4509636001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
