|
STENT COTTON HUIB 10X9
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.04 |
| Max. Negotiated Rate |
$275.48 |
| Rate for Payer: AlohaCare Medicaid |
$142.00
|
| Rate for Payer: AlohaCare Medicare |
$88.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Devoted Health Medicare |
$96.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.80
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Humana Medicare |
$88.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$255.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.04
|
| Rate for Payer: MDX Hawaii PPO |
$275.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.04
|
| Rate for Payer: University Health Alliance Commercial |
$159.04
|
|
|
STENT COTTON HUIB 10X9
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$275.48 |
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.80
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$255.60
|
| Rate for Payer: MDX Hawaii PPO |
$275.48
|
| Rate for Payer: University Health Alliance Commercial |
$159.04
|
|
|
STENT ENDOPYELOTOMY
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.28 |
| Max. Negotiated Rate |
$715.86 |
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.60
|
| Rate for Payer: Health Management Network Commercial |
$627.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$664.20
|
| Rate for Payer: MDX Hawaii PPO |
$715.86
|
| Rate for Payer: University Health Alliance Commercial |
$413.28
|
|
|
STENT ENDOPYELOTOMY
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.78 |
| Max. Negotiated Rate |
$715.86 |
| Rate for Payer: AlohaCare Medicaid |
$369.00
|
| Rate for Payer: AlohaCare Medicare |
$228.78
|
| Rate for Payer: Cash Price |
$442.80
|
| Rate for Payer: Devoted Health Medicare |
$250.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$516.60
|
| Rate for Payer: Health Management Network Commercial |
$627.30
|
| Rate for Payer: Humana Medicare |
$228.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$664.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$228.78
|
| Rate for Payer: MDX Hawaii PPO |
$715.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$228.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.78
|
| Rate for Payer: University Health Alliance Commercial |
$413.28
|
|
|
STENT ERCP BILIARY 11.5X7
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C2625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,071.00
|
| Rate for Payer: Health Management Network Commercial |
$1,300.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,377.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,484.10
|
| Rate for Payer: University Health Alliance Commercial |
$856.80
|
|
|
STENT ERCP BILIARY 11.5X7
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C2625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.30 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: AlohaCare Medicaid |
$765.00
|
| Rate for Payer: AlohaCare Medicare |
$474.30
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Devoted Health Medicare |
$520.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$474.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,071.00
|
| Rate for Payer: Health Management Network Commercial |
$1,300.50
|
| Rate for Payer: Humana Medicare |
$474.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,377.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$780.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$474.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,484.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$474.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$474.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$474.30
|
| Rate for Payer: University Health Alliance Commercial |
$856.80
|
|
|
STENT ESOPHAGEAL 18MM
|
Facility
|
OP
|
$4,840.00
|
|
|
Service Code
|
HCPCS C1874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.40 |
| Max. Negotiated Rate |
$4,694.80 |
| Rate for Payer: AlohaCare Medicaid |
$2,420.00
|
| Rate for Payer: AlohaCare Medicaid |
$2,420.50
|
| Rate for Payer: AlohaCare Medicare |
$1,500.40
|
| Rate for Payer: AlohaCare Medicare |
$1,500.71
|
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Cash Price |
$2,904.60
|
| Rate for Payer: Devoted Health Medicare |
$1,645.60
|
| Rate for Payer: Devoted Health Medicare |
$1,645.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,500.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,500.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,388.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,388.00
|
| Rate for Payer: Health Management Network Commercial |
$4,114.00
|
| Rate for Payer: Health Management Network Commercial |
$4,114.85
|
| Rate for Payer: Humana Medicare |
$1,500.40
|
| Rate for Payer: Humana Medicare |
$1,500.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,356.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,356.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,468.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,468.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,500.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,500.71
|
| Rate for Payer: MDX Hawaii PPO |
$4,694.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,695.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,500.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,500.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,500.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,500.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,500.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,500.71
|
| Rate for Payer: University Health Alliance Commercial |
$2,710.40
|
| Rate for Payer: University Health Alliance Commercial |
$2,710.96
|
|
|
STENT ESOPHAGEAL 18MM
|
Facility
|
IP
|
$4,840.00
|
|
|
Service Code
|
HCPCS C1874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,710.40 |
| Max. Negotiated Rate |
$4,694.80 |
| Rate for Payer: Cash Price |
$2,904.00
|
| Rate for Payer: Cash Price |
$2,904.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,388.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,388.70
|
| Rate for Payer: Health Management Network Commercial |
$4,114.00
|
| Rate for Payer: Health Management Network Commercial |
$4,114.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,356.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,356.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,694.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,695.77
|
| Rate for Payer: University Health Alliance Commercial |
$2,710.96
|
| Rate for Payer: University Health Alliance Commercial |
$2,710.40
|
|
|
STENT ESOPHAGEAL 18MMX153
|
Facility
|
IP
|
$4,841.00
|
|
|
Service Code
|
HCPCS C1874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,710.96 |
| Max. Negotiated Rate |
$4,695.77 |
| Rate for Payer: Cash Price |
$2,904.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,388.70
|
| Rate for Payer: Health Management Network Commercial |
$4,114.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,356.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,695.77
|
| Rate for Payer: University Health Alliance Commercial |
$2,710.96
|
|
|
STENT ESOPHAGEAL 18MMX153
|
Facility
|
OP
|
$4,841.00
|
|
|
Service Code
|
HCPCS C1874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.71 |
| Max. Negotiated Rate |
$4,695.77 |
| Rate for Payer: AlohaCare Medicaid |
$2,420.50
|
| Rate for Payer: AlohaCare Medicare |
$1,500.71
|
| Rate for Payer: Cash Price |
$2,904.60
|
| Rate for Payer: Devoted Health Medicare |
$1,645.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,500.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,388.70
|
| Rate for Payer: Health Management Network Commercial |
$4,114.85
|
| Rate for Payer: Humana Medicare |
$1,500.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,356.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,468.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,500.71
|
| Rate for Payer: MDX Hawaii PPO |
$4,695.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,500.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,500.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,500.71
|
| Rate for Payer: University Health Alliance Commercial |
$2,710.96
|
|
|
STENT ESOPHAGEAL 23MM
|
Facility
|
OP
|
$5,160.00
|
|
|
Service Code
|
HCPCS C1874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,599.60 |
| Max. Negotiated Rate |
$5,005.20 |
| Rate for Payer: AlohaCare Medicaid |
$2,580.00
|
| Rate for Payer: AlohaCare Medicare |
$1,599.60
|
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Devoted Health Medicare |
$1,754.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,599.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,612.00
|
| Rate for Payer: Health Management Network Commercial |
$4,386.00
|
| Rate for Payer: Humana Medicare |
$1,599.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,644.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,631.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,599.60
|
| Rate for Payer: MDX Hawaii PPO |
$5,005.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,599.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,599.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,599.60
|
| Rate for Payer: University Health Alliance Commercial |
$2,889.60
|
|
|
STENT ESOPHAGEAL 23MM
|
Facility
|
IP
|
$5,160.00
|
|
|
Service Code
|
HCPCS C1874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,889.60 |
| Max. Negotiated Rate |
$5,005.20 |
| Rate for Payer: Cash Price |
$3,096.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,612.00
|
| Rate for Payer: Health Management Network Commercial |
$4,386.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,644.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,005.20
|
| Rate for Payer: University Health Alliance Commercial |
$2,889.60
|
|
|
STENT GASTROINTESTINAL DUODENL
|
Facility
|
IP
|
$5,075.00
|
|
|
Service Code
|
HCPCS C1876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.00 |
| Max. Negotiated Rate |
$4,922.75 |
| Rate for Payer: Cash Price |
$3,045.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,552.50
|
| Rate for Payer: Health Management Network Commercial |
$4,313.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,567.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,922.75
|
| Rate for Payer: University Health Alliance Commercial |
$2,842.00
|
|
|
STENT GASTROINTESTINAL DUODENL
|
Facility
|
OP
|
$5,075.00
|
|
|
Service Code
|
HCPCS C1876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,573.25 |
| Max. Negotiated Rate |
$4,922.75 |
| Rate for Payer: AlohaCare Medicaid |
$2,537.50
|
| Rate for Payer: AlohaCare Medicare |
$1,573.25
|
| Rate for Payer: Cash Price |
$3,045.00
|
| Rate for Payer: Devoted Health Medicare |
$1,725.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,573.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,552.50
|
| Rate for Payer: Health Management Network Commercial |
$4,313.75
|
| Rate for Payer: Humana Medicare |
$1,573.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,567.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,588.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,573.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,922.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,573.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,573.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,573.25
|
| Rate for Payer: University Health Alliance Commercial |
$2,842.00
|
|
|
STENT GRAFT AAA26X20 TGM262610
|
Facility
|
IP
|
$44,598.00
|
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,974.88 |
| Max. Negotiated Rate |
$43,260.06 |
| Rate for Payer: Cash Price |
$26,758.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31,218.60
|
| Rate for Payer: Health Management Network Commercial |
$37,908.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$40,138.20
|
| Rate for Payer: MDX Hawaii PPO |
$43,260.06
|
| Rate for Payer: University Health Alliance Commercial |
$24,974.88
|
|
|
STENT GRAFT AAA26X20 TGM262610
|
Facility
|
OP
|
$44,598.00
|
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,825.38 |
| Max. Negotiated Rate |
$43,260.06 |
| Rate for Payer: AlohaCare Medicaid |
$22,299.00
|
| Rate for Payer: AlohaCare Medicare |
$13,825.38
|
| Rate for Payer: Cash Price |
$26,758.80
|
| Rate for Payer: Devoted Health Medicare |
$15,163.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13,825.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31,218.60
|
| Rate for Payer: Health Management Network Commercial |
$37,908.30
|
| Rate for Payer: Humana Medicare |
$13,825.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$40,138.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22,744.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$13,825.38
|
| Rate for Payer: MDX Hawaii PPO |
$43,260.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,825.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$13,825.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$13,825.38
|
| Rate for Payer: University Health Alliance Commercial |
$24,974.88
|
|
|
STENT PANCREATIC 5FX3CM
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.96 |
| Max. Negotiated Rate |
$306.52 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$221.20
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$284.40
|
| Rate for Payer: MDX Hawaii PPO |
$306.52
|
| Rate for Payer: University Health Alliance Commercial |
$176.96
|
|
|
STENT PANCREATIC 5FX3CM
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$306.52 |
| Rate for Payer: AlohaCare Medicaid |
$158.00
|
| Rate for Payer: AlohaCare Medicare |
$97.96
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Devoted Health Medicare |
$107.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$221.20
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Humana Medicare |
$97.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$284.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.96
|
| Rate for Payer: MDX Hawaii PPO |
$306.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.96
|
| Rate for Payer: University Health Alliance Commercial |
$176.96
|
|
|
STENT POLARIS LOOP M0061552300
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$312.48 |
| Max. Negotiated Rate |
$541.26 |
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network Commercial |
$474.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$502.20
|
| Rate for Payer: MDX Hawaii PPO |
$541.26
|
| Rate for Payer: University Health Alliance Commercial |
$312.48
|
|
|
STENT POLARIS LOOP M0061552300
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$172.98 |
| Max. Negotiated Rate |
$541.26 |
| Rate for Payer: AlohaCare Medicaid |
$279.00
|
| Rate for Payer: AlohaCare Medicare |
$172.98
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Devoted Health Medicare |
$189.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network Commercial |
$474.30
|
| Rate for Payer: Humana Medicare |
$172.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$502.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$284.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.98
|
| Rate for Payer: MDX Hawaii PPO |
$541.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.98
|
| Rate for Payer: University Health Alliance Commercial |
$312.48
|
|
|
STENT POLARIS LOOP URETERAL
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.12 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$398.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network Commercial |
$483.65
|
| Rate for Payer: Health Management Network Commercial |
$469.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$512.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$496.80
|
| Rate for Payer: MDX Hawaii PPO |
$551.93
|
| Rate for Payer: MDX Hawaii PPO |
$535.44
|
| Rate for Payer: University Health Alliance Commercial |
$318.64
|
| Rate for Payer: University Health Alliance Commercial |
$309.12
|
|
|
STENT POLARIS LOOP URETERAL
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.39 |
| Max. Negotiated Rate |
$551.93 |
| Rate for Payer: AlohaCare Medicaid |
$284.50
|
| Rate for Payer: AlohaCare Medicaid |
$276.00
|
| Rate for Payer: AlohaCare Medicare |
$176.39
|
| Rate for Payer: AlohaCare Medicare |
$171.12
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Devoted Health Medicare |
$187.68
|
| Rate for Payer: Devoted Health Medicare |
$193.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$176.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$386.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$398.30
|
| Rate for Payer: Health Management Network Commercial |
$483.65
|
| Rate for Payer: Health Management Network Commercial |
$469.20
|
| Rate for Payer: Humana Medicare |
$176.39
|
| Rate for Payer: Humana Medicare |
$171.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$496.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$512.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$281.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.12
|
| Rate for Payer: MDX Hawaii PPO |
$535.44
|
| Rate for Payer: MDX Hawaii PPO |
$551.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$176.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$176.39
|
| Rate for Payer: University Health Alliance Commercial |
$318.64
|
| Rate for Payer: University Health Alliance Commercial |
$309.12
|
|
|
STENT PUSHER 4/5FR
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: AlohaCare Medicaid |
$100.50
|
| Rate for Payer: AlohaCare Medicare |
$62.31
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Devoted Health Medicare |
$68.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$140.70
|
| Rate for Payer: Health Management Network Commercial |
$170.85
|
| Rate for Payer: Humana Medicare |
$62.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.31
|
| Rate for Payer: MDX Hawaii PPO |
$194.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.31
|
| Rate for Payer: University Health Alliance Commercial |
$112.56
|
|
|
STENT PUSHER 4/5FR
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS C1889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$140.70
|
| Rate for Payer: Health Management Network Commercial |
$170.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.90
|
| Rate for Payer: MDX Hawaii PPO |
$194.97
|
| Rate for Payer: University Health Alliance Commercial |
$112.56
|
|
|
STENT SET FILIFORM DBL PIG
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS C2617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.63 |
| Max. Negotiated Rate |
$458.81 |
| Rate for Payer: AlohaCare Medicaid |
$236.50
|
| Rate for Payer: AlohaCare Medicaid |
$266.00
|
| Rate for Payer: AlohaCare Medicare |
$146.63
|
| Rate for Payer: AlohaCare Medicare |
$164.92
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Devoted Health Medicare |
$160.82
|
| Rate for Payer: Devoted Health Medicare |
$180.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$372.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.10
|
| Rate for Payer: Health Management Network Commercial |
$402.05
|
| Rate for Payer: Health Management Network Commercial |
$452.20
|
| Rate for Payer: Humana Medicare |
$146.63
|
| Rate for Payer: Humana Medicare |
$164.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$478.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$425.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$241.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$271.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.92
|
| Rate for Payer: MDX Hawaii PPO |
$458.81
|
| Rate for Payer: MDX Hawaii PPO |
$516.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.92
|
| Rate for Payer: University Health Alliance Commercial |
$264.88
|
| Rate for Payer: University Health Alliance Commercial |
$297.92
|
|
