|
HC REMOVAL VAGINAL FOR.BODY W ANESTH
|
Facility
|
IP
|
$12,653.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
7615741501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,755.05 |
| Max. Negotiated Rate |
$12,273.41 |
| Rate for Payer: Cash Price |
$7,591.80
|
| Rate for Payer: Health Management Network Commercial |
$10,755.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,387.70
|
| Rate for Payer: MDX Hawaii PPO |
$12,273.41
|
|
|
HC REMOVE FOREIGN BODY COMPLIC
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
7611012101
|
|
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 REMOVE FOREIGN BODY COMPLIC
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
7611012101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,998.88
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC REMOVE FOREIGN BODY SIMPLE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
3611012001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.57 |
| Max. Negotiated Rate |
$5,160.40 |
| 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: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$540.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$519.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$492.90
|
| 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 |
$2,837.00
|
| 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 Medicaid |
$54.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC REMOVE FOREIGN BODY SIMPLE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
7611012001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
|
HC REMOVE FOREIGN BODY SIMPLE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
7611012001
|
|
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 REMOVE FOREIGN BODY SIMPLE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
3611012001
|
|
Hospital Revenue Code
|
361
|
| 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 REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
7613030001
|
|
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 REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
7613030001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.73 |
| 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 |
$73.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC REMV EXT CANAL FOREIGN BODY
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
7616920001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.80 |
| 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 |
$35.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC REMV EXT CANAL FOREIGN BODY
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
7616920001
|
|
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 REMV F.B.,EYE,CORNEA,NO SLIT
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
4506522001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$794.00
|
| Rate for Payer: AlohaCare Medicare |
$492.28
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Devoted Health Medicare |
$539.92
|
| 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 |
$492.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,508.60
|
| Rate for Payer: Health Management Network Commercial |
$1,349.80
|
| Rate for Payer: Humana Medicare |
$492.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,429.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.28
|
| Rate for Payer: MDX Hawaii PPO |
$1,540.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.28
|
| Rate for Payer: University Health Alliance Commercial |
$1,157.49
|
|
|
HC REMV F.B.,EYE,CORNEA,NO SLIT
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
4506522001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,349.80 |
| Max. Negotiated Rate |
$1,540.36 |
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Health Management Network Commercial |
$1,349.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,429.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,540.36
|
|
|
HC REMV F.B.,EYE,CORNEA,SLIT LAMP
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
4506522201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.03 |
| Max. Negotiated Rate |
$1,600.00 |
| 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: Devoted Health Medicare |
$174.42
|
| 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 |
$159.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC REMV F.B.,EYE,CORNEA,SLIT LAMP
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
4506522201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC REMV F.B.,EYE,EMBED CONJUNC
|
Facility
|
OP
|
$1,588.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
3616521001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$794.00
|
| Rate for Payer: AlohaCare Medicare |
$492.28
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Devoted Health Medicare |
$539.92
|
| 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 |
$492.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,508.60
|
| Rate for Payer: Health Management Network Commercial |
$1,349.80
|
| Rate for Payer: Humana Medicare |
$492.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,429.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.28
|
| Rate for Payer: MDX Hawaii PPO |
$1,540.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.28
|
| Rate for Payer: University Health Alliance Commercial |
$1,157.49
|
|
|
HC REMV F.B.,EYE,EMBED CONJUNC
|
Facility
|
IP
|
$1,588.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
3616521001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,349.80 |
| Max. Negotiated Rate |
$1,540.36 |
| Rate for Payer: Cash Price |
$952.80
|
| Rate for Payer: Health Management Network Commercial |
$1,349.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,429.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,540.36
|
|
|
HC RENAL FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
3018006901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| 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 |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.68
|
| 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 |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.63
|
| Rate for Payer: University Health Alliance Commercial |
$22.44
|
|
|
HC RENAL FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
3018006901
|
|
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 REPAIR, COMPLEX, EYELIDS, NOSE, EARS, LIPS; EACH ADDITIONAL 5 CM OR LESS
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
4501315301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$667.25 |
| Max. Negotiated Rate |
$761.45 |
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Health Management Network Commercial |
$667.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$706.50
|
| Rate for Payer: MDX Hawaii PPO |
$761.45
|
|
|
HC REPAIR, COMPLEX, EYELIDS, NOSE, EARS, LIPS; EACH ADDITIONAL 5 CM OR LESS
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
4501315301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.35 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$392.50
|
| Rate for Payer: AlohaCare Medicare |
$243.35
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Devoted Health Medicare |
$266.90
|
| 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 |
$243.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$745.75
|
| Rate for Payer: Health Management Network Commercial |
$667.25
|
| Rate for Payer: Humana Medicare |
$243.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$706.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.35
|
| Rate for Payer: MDX Hawaii PPO |
$761.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.35
|
| Rate for Payer: University Health Alliance Commercial |
$572.19
|
|
|
HC REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
4501312001
|
|
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 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
4501312001
|
|
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 REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM
|
Facility
|
IP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
4501310001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,027.25 |
| Max. Negotiated Rate |
$2,313.45 |
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Health Management Network Commercial |
$2,027.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,146.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,313.45
|
|
|
HC REPAIR, COMPLEX, TRUNK; 1.1 CM TO 2.5 CM
|
Facility
|
OP
|
$2,385.00
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
4501310001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,313.45 |
| Rate for Payer: AlohaCare Medicaid |
$1,192.50
|
| Rate for Payer: AlohaCare Medicare |
$739.35
|
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Cash Price |
$1,431.00
|
| Rate for Payer: Devoted Health Medicare |
$810.90
|
| 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 |
$739.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,265.75
|
| Rate for Payer: Health Management Network Commercial |
$2,027.25
|
| Rate for Payer: Humana Medicare |
$739.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,146.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$739.35
|
| Rate for Payer: MDX Hawaii PPO |
$2,313.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$739.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$739.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$739.35
|
| Rate for Payer: University Health Alliance Commercial |
$1,738.43
|
|
