|
HC RT NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94762
|
| Hospital Charge Code |
4109476201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$591.70 |
| Rate for Payer: AlohaCare Medicaid |
$305.00
|
| Rate for Payer: AlohaCare Medicare |
$189.10
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Devoted Health Medicare |
$207.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$164.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$579.50
|
| Rate for Payer: Health Management Network Commercial |
$518.50
|
| Rate for Payer: Humana Medicare |
$189.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$549.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$311.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$189.10
|
| Rate for Payer: MDX Hawaii PPO |
$591.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.10
|
| Rate for Payer: University Health Alliance Commercial |
$444.63
|
|
|
HC RT VENT MGMT, INPATIENT, INITIAL DAY
|
Facility
|
OP
|
$3,552.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4109400201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$3,445.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,776.00
|
| Rate for Payer: AlohaCare Medicare |
$1,101.12
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Devoted Health Medicare |
$1,207.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$788.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,101.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,374.40
|
| Rate for Payer: Health Management Network Commercial |
$3,019.20
|
| Rate for Payer: Humana Medicare |
$1,101.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,196.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,811.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,101.12
|
| Rate for Payer: MDX Hawaii PPO |
$3,445.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,101.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,101.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,101.12
|
| Rate for Payer: University Health Alliance Commercial |
$2,589.05
|
|
|
HC RT VENT MGMT, INPATIENT, INITIAL DAY
|
Facility
|
IP
|
$3,552.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
4109400201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3,019.20 |
| Max. Negotiated Rate |
$3,445.44 |
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Health Management Network Commercial |
$3,019.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,196.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,445.44
|
|
|
HC RT VENT MGMT, INPATIENT, SUBQ DAY
|
Facility
|
OP
|
$3,552.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4109400301
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$3,445.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,776.00
|
| Rate for Payer: AlohaCare Medicare |
$1,101.12
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Devoted Health Medicare |
$1,207.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$788.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,101.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,374.40
|
| Rate for Payer: Health Management Network Commercial |
$3,019.20
|
| Rate for Payer: Humana Medicare |
$1,101.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,196.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,811.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,101.12
|
| Rate for Payer: MDX Hawaii PPO |
$3,445.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,101.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,101.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,101.12
|
| Rate for Payer: University Health Alliance Commercial |
$2,589.05
|
|
|
HC RT VENT MGMT, INPATIENT, SUBQ DAY
|
Facility
|
IP
|
$3,552.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
4109400301
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3,019.20 |
| Max. Negotiated Rate |
$3,445.44 |
| Rate for Payer: Cash Price |
$2,131.20
|
| Rate for Payer: Health Management Network Commercial |
$3,019.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,196.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,445.44
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGM
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.90
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
|
|
HC RUBELLA - RUBELLA ANTIBODY, IGM
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
3028676201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: AlohaCare Medicaid |
$60.50
|
| Rate for Payer: AlohaCare Medicare |
$37.51
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$41.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Humana Medicare |
$37.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.51
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.51
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY IGG
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$36.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$33.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.48
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.48
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY IGG
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY, IGM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC RUBEOLA - RUBEOLA ANTIBODY, IGM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
3028676502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$36.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$33.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.48
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.48
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HC SARSCOVID19 RAPID ANTIGEN POCT
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
3068781101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$336.59 |
| Rate for Payer: AlohaCare Medicaid |
$173.50
|
| Rate for Payer: AlohaCare Medicare |
$107.57
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Devoted Health Medicare |
$117.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.38
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Humana Medicare |
$107.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.57
|
| Rate for Payer: MDX Hawaii PPO |
$336.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.57
|
| Rate for Payer: University Health Alliance Commercial |
$252.93
|
|
|
HC SARSCOVID19 RAPID ANTIGEN POCT
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
3068781101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$294.95 |
| Max. Negotiated Rate |
$336.59 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$312.30
|
| Rate for Payer: MDX Hawaii PPO |
$336.59
|
|
|
HC SENSITIVITY PER ENZYME
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3068718501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.40
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.40
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
HC SENSITIVITY PER ENZYME
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3068718501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY - ENDOSCOPY SIGMOID
|
Facility
|
IP
|
$4,595.00
|
|
|
Service Code
|
HCPCS 45332
|
| Hospital Charge Code |
7504533201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,905.75 |
| Max. Negotiated Rate |
$4,457.15 |
| Rate for Payer: Cash Price |
$2,757.00
|
| Rate for Payer: Health Management Network Commercial |
$3,905.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,135.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,457.15
|
|
|
HC SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY - ENDOSCOPY SIGMOID
|
Facility
|
OP
|
$4,595.00
|
|
|
Service Code
|
HCPCS 45332
|
| Hospital Charge Code |
7504533201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,457.15 |
| Rate for Payer: AlohaCare Medicaid |
$2,297.50
|
| Rate for Payer: AlohaCare Medicare |
$1,424.45
|
| Rate for Payer: Cash Price |
$2,757.00
|
| Rate for Payer: Cash Price |
$2,757.00
|
| Rate for Payer: Devoted Health Medicare |
$1,562.30
|
| 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 |
$1,424.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,365.25
|
| Rate for Payer: Health Management Network Commercial |
$3,905.75
|
| Rate for Payer: Humana Medicare |
$1,424.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,135.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,424.45
|
| Rate for Payer: MDX Hawaii PPO |
$4,457.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,424.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,424.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,424.45
|
| Rate for Payer: University Health Alliance Commercial |
$3,349.30
|
|
|
HC SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
4501201701
|
|
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; 20.1 TO 30.0 CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12017
|
| Hospital Charge Code |
4501201701
|
|
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
4501201801
|
|
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 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MUCOUS MEMBRANES; OVER 30.0 CM
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
4501201801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$245.21
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$268.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$245.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.21
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.21
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC SLP ASSESSMENT OF APHASIA
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
4449610501
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
HC SLP ASSESSMENT OF APHASIA
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 96105
|
| Hospital Charge Code |
4449610501
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: AlohaCare Medicaid |
$227.00
|
| Rate for Payer: AlohaCare Medicare |
$140.74
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Devoted Health Medicare |
$154.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$431.30
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$140.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.74
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.74
|
| Rate for Payer: University Health Alliance Commercial |
$330.92
|
|
|
HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
HCPCS 92524
|
| Hospital Charge Code |
4449252401
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$443.70 |
| Max. Negotiated Rate |
$506.34 |
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.80
|
| Rate for Payer: MDX Hawaii PPO |
$506.34
|
|
|
HC SLP BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
HCPCS 92524
|
| Hospital Charge Code |
4449252401
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$506.34 |
| Rate for Payer: AlohaCare Medicaid |
$261.00
|
| Rate for Payer: AlohaCare Medicare |
$161.82
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Cash Price |
$313.20
|
| Rate for Payer: Devoted Health Medicare |
$177.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.90
|
| Rate for Payer: Health Management Network Commercial |
$443.70
|
| Rate for Payer: Humana Medicare |
$161.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$469.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$266.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.82
|
| Rate for Payer: MDX Hawaii PPO |
$506.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.82
|
| Rate for Payer: University Health Alliance Commercial |
$380.49
|
|
