|
HC REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
7612052001
|
|
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 REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
7612052001
|
|
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 REMOVAL OF FOREIGN BODY FROM SCROTUM
|
Facility
|
OP
|
$7,982.00
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
4505512001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,742.54 |
| Rate for Payer: AlohaCare Medicaid |
$3,991.00
|
| Rate for Payer: AlohaCare Medicare |
$2,474.42
|
| Rate for Payer: Cash Price |
$4,789.20
|
| Rate for Payer: Cash Price |
$4,789.20
|
| Rate for Payer: Devoted Health Medicare |
$2,713.88
|
| 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 |
$2,474.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,582.90
|
| Rate for Payer: Health Management Network Commercial |
$6,784.70
|
| Rate for Payer: Humana Medicare |
$2,474.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,183.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,474.42
|
| Rate for Payer: MDX Hawaii PPO |
$7,742.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,474.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,474.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,474.42
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC REMOVAL OF FOREIGN BODY FROM SCROTUM
|
Facility
|
IP
|
$7,982.00
|
|
|
Service Code
|
HCPCS 55120
|
| Hospital Charge Code |
4505512001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,784.70 |
| Max. Negotiated Rate |
$7,742.54 |
| Rate for Payer: Cash Price |
$4,789.20
|
| Rate for Payer: Health Management Network Commercial |
$6,784.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,183.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,742.54
|
|
|
HC REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
4502052501
|
|
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 REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
4502052501
|
|
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 |
$6,743.44
|
|
|
HC REMOVAL OF FOREIGN BODY, PELVIS OR HIP JOINT AREA; DEEP
|
Facility
|
OP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
4502708701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,263.71 |
| Rate for Payer: AlohaCare Medicaid |
$6,321.50
|
| Rate for Payer: AlohaCare Medicare |
$3,919.33
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Cash Price |
$7,585.80
|
| Rate for Payer: Devoted Health Medicare |
$4,298.62
|
| 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 |
$3,919.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,010.85
|
| Rate for Payer: Health Management Network Commercial |
$10,746.55
|
| Rate for Payer: Humana Medicare |
$3,919.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,378.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,919.33
|
| Rate for Payer: MDX Hawaii PPO |
$12,263.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,919.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,919.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,919.33
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC REMOVAL OF FOREIGN BODY, PELVIS OR HIP JOINT AREA; DEEP
|
Facility
|
IP
|
$12,643.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
4502708701
|
|
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 REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBQ TISSUE
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 27086
|
| Hospital Charge Code |
4502708601
|
|
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 REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBQ TISSUE
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 27086
|
| Hospital Charge Code |
4502708601
|
|
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 REMOVAL OF FOREIGN BODY, SHOULDER; DEEP
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
4502333301
|
|
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 REMOVAL OF FOREIGN BODY, SHOULDER; DEEP
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
4502333301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,457.43
|
| Rate for Payer: University Health Alliance Commercial |
$8,129.42
|
|
|
HC REMOVAL OF FOREIGN BODY, SHOULDER; SUBQ
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 23330
|
| Hospital Charge Code |
4502333001
|
|
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 |
$4,035.20
|
|
|
HC REMOVAL OF FOREIGN BODY, SHOULDER; SUBQ
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 23330
|
| Hospital Charge Code |
4502333001
|
|
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 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP
|
Facility
|
IP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
4502420101
|
|
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 REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP
|
Facility
|
OP
|
$11,153.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
4502420101
|
|
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 |
$5,160.40
|
|
|
HC REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBQ
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
4502420001
|
|
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 |
$4,035.20
|
|
|
HC REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBQ
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
4502420001
|
|
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 REMOVAL OF NAIL BED
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
4501175001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$492.90
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$540.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$492.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$492.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC REMOVAL OF NAIL BED
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
4501175001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC REMOVAL OF NAIL PLATE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4501173001
|
|
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 REMOVAL OF NAIL PLATE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
4501173001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$4,035.20
|
|
|
HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4501585301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$28.50
|
| Rate for Payer: AlohaCare Medicare |
$17.67
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$19.38
|
| 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 |
$17.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.15
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Humana Medicare |
$17.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.67
|
| Rate for Payer: MDX Hawaii PPO |
$55.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.67
|
| Rate for Payer: University Health Alliance Commercial |
$41.55
|
|
|
HC REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
4501585301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$55.29 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.30
|
| Rate for Payer: MDX Hawaii PPO |
$55.29
|
|
|
HC REMOVAL VAGINAL FOR.BODY W ANESTH
|
Facility
|
OP
|
$12,653.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
7615741501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,273.41 |
| Rate for Payer: AlohaCare Medicaid |
$6,326.50
|
| Rate for Payer: AlohaCare Medicare |
$3,922.43
|
| Rate for Payer: Cash Price |
$7,591.80
|
| Rate for Payer: Cash Price |
$7,591.80
|
| Rate for Payer: Devoted Health Medicare |
$4,302.02
|
| 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 |
$3,922.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,020.35
|
| Rate for Payer: Health Management Network Commercial |
$10,755.05
|
| Rate for Payer: Humana Medicare |
$3,922.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,387.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,922.43
|
| Rate for Payer: MDX Hawaii PPO |
$12,273.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,922.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,922.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,922.43
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
