|
HC STRAP HIP
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
4202952001
|
|
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 STRAP HIP
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
4202952001
|
|
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 STRAPPING; TOES
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
4502955001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC STRAPPING; TOES
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
4502955001
|
|
Hospital Revenue Code
|
450
|
| 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 STRAPPING UNNA BOOT
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
7002958001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
7002958001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.68 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$314.00
|
| Rate for Payer: AlohaCare Medicare |
$194.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$213.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$194.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.68
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.68
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC STRAP SHOULDER
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
4202924001
|
|
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 STRAP SHOULDER
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
4202924001
|
|
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 STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
3068788001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$43.09
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$47.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$43.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.09
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.09
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
3068788001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
HC STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
3068765101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$91.14
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$99.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$91.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.14
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
3068765101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC STRESS TTE COMPLETE
|
Facility
|
IP
|
$2,728.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4839335101
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,318.80 |
| Max. Negotiated Rate |
$2,646.16 |
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Health Management Network Commercial |
$2,318.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,455.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,646.16
|
|
|
HC STRESS TTE COMPLETE
|
Facility
|
OP
|
$2,728.00
|
|
|
Service Code
|
HCPCS 93351
|
| Hospital Charge Code |
4839335101
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$183.31 |
| Max. Negotiated Rate |
$2,646.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,364.00
|
| Rate for Payer: AlohaCare Medicare |
$845.68
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Devoted Health Medicare |
$927.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$845.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,591.60
|
| Rate for Payer: Health Management Network Commercial |
$2,318.80
|
| Rate for Payer: Humana Medicare |
$845.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,455.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,391.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$845.68
|
| Rate for Payer: MDX Hawaii PPO |
$2,646.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$845.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$845.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$183.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$845.68
|
| Rate for Payer: University Health Alliance Commercial |
$1,988.44
|
|
|
HC STRESS TTE W/ECG W/CONT
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
HCPCS C8930
|
| Hospital Charge Code |
483C893001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$592.55 |
| Max. Negotiated Rate |
$3,812.10 |
| Rate for Payer: AlohaCare Medicaid |
$1,965.00
|
| Rate for Payer: AlohaCare Medicare |
$1,218.30
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Devoted Health Medicare |
$1,336.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,001.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,218.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,733.50
|
| Rate for Payer: Health Management Network Commercial |
$3,340.50
|
| Rate for Payer: Humana Medicare |
$1,218.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,537.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,004.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,218.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,812.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,218.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,218.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$592.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,218.30
|
| Rate for Payer: University Health Alliance Commercial |
$2,864.58
|
|
|
HC STRESS TTE W/ECG W/CONT
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
HCPCS C8930
|
| Hospital Charge Code |
483C893001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$3,340.50 |
| Max. Negotiated Rate |
$3,812.10 |
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Health Management Network Commercial |
$3,340.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,537.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,812.10
|
|
|
HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 88300 TC
|
| Hospital Charge Code |
3128830001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$75.33
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$82.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.85
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$75.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.33
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.33
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
|
HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 88300 TC
|
| Hospital Charge Code |
3128830001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 88304 TC
|
| Hospital Charge Code |
3128830401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$502.55
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$106.78
|
|
|
HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 88304 TC
|
| Hospital Charge Code |
3128830401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 88302 TC
|
| Hospital Charge Code |
3128830201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: AlohaCare Medicaid |
$194.50
|
| Rate for Payer: AlohaCare Medicare |
$120.59
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Devoted Health Medicare |
$132.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$369.55
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$120.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.59
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.59
|
| Rate for Payer: University Health Alliance Commercial |
$89.95
|
|
|
HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 88302 TC
|
| Hospital Charge Code |
3128830201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
|
HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
3128830501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 88305 TC
|
| Hospital Charge Code |
3128830501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$502.55
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$139.05
|
|
|
HC SUTURE EYELID WOUND,FULL THICK
|
Facility
|
OP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67935
|
| Hospital Charge Code |
3616793501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: AlohaCare Medicaid |
$4,545.50
|
| Rate for Payer: AlohaCare Medicare |
$2,818.21
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Devoted Health Medicare |
$3,090.94
|
| 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 |
$2,818.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,636.45
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Humana Medicare |
$2,818.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,818.21
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,818.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,818.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,818.21
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
