|
HC RADIOLOGIC EXAM CHEST SINGLE VIEW - XR CHEST 1 VIEW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
3247104502
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$57.63
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$67.43
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
3058565101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$9.18
|
|
|
HC RBC SED RATE, NONAUTO - SEDIMENTATION RATE, MANUAL
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
3058565101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
4501313201
|
|
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 RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
4501313201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,679.55 |
| 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 |
$10,679.55
|
|
|
HC RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
4501312101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
|
HC RECMPL WND SCALP,EXTR 2.6-7.5 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
4501312101
|
|
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 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7616921001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
7616921001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$73.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$80.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$73.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.16
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
7616920901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.16 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$73.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$80.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$73.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.16
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
7616920901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
4506793801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
4506793801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$368.90 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$595.00
|
| Rate for Payer: AlohaCare Medicare |
$368.90
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Devoted Health Medicare |
$404.60
|
| 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 |
$368.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,130.50
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$368.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$368.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$368.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$368.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$368.90
|
| Rate for Payer: University Health Alliance Commercial |
$867.39
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
|
Facility
|
IP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 41805
|
| Hospital Charge Code |
4504180501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,906.20 |
| Max. Negotiated Rate |
$5,598.84 |
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Health Management Network Commercial |
$4,906.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,194.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY FROM DENTOALVEOLAR STRUCTURES; SOFT TISSUES
|
Facility
|
OP
|
$5,772.00
|
|
|
Service Code
|
HCPCS 41805
|
| Hospital Charge Code |
4504180501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,598.84 |
| Rate for Payer: AlohaCare Medicaid |
$2,886.00
|
| Rate for Payer: AlohaCare Medicare |
$1,789.32
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Cash Price |
$3,463.20
|
| Rate for Payer: Devoted Health Medicare |
$1,962.48
|
| 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 |
$1,789.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,483.40
|
| Rate for Payer: Health Management Network Commercial |
$4,906.20
|
| Rate for Payer: Humana Medicare |
$1,789.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,194.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,789.32
|
| Rate for Payer: MDX Hawaii PPO |
$5,598.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,789.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,789.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,789.32
|
| Rate for Payer: University Health Alliance Commercial |
$4,207.21
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
4504080501
|
|
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 REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
4504080501
|
|
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 REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
4504080401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,171.35 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,357.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
|
|
HC REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
4504080401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: AlohaCare Medicaid |
$1,865.50
|
| Rate for Payer: AlohaCare Medicare |
$1,156.61
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Devoted Health Medicare |
$1,268.54
|
| 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 |
$1,156.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,544.45
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: Humana Medicare |
$1,156.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,357.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,156.61
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,156.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,156.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,156.61
|
| Rate for Payer: University Health Alliance Commercial |
$2,719.53
|
|
|
HC REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4504591501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,551.24 |
| 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 |
$3,420.00
|
|
|
HC REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
4504591501
|
|
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
|
|
