|
31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
8211215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$825.00
|
| Rate for Payer: AlohaCare Medicare |
$825.00
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,072.50
|
| Rate for Payer: Devoted Health Medicare |
$907.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$825.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,567.50
|
| Rate for Payer: Health Management Network Commercial |
$1,402.50
|
| Rate for Payer: Humana Medicare |
$825.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,485.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$825.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,600.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$825.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$825.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
31500 INTUBATION ENDOTRACHEAL - ER SERV PROCED
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
8051020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$580.00
|
| Rate for Payer: AlohaCare Medicare |
$580.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Devoted Health Medicare |
$638.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,102.00
|
| Rate for Payer: Health Management Network Commercial |
$986.00
|
| Rate for Payer: Humana Medicare |
$580.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,044.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$591.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$580.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,125.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$580.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
31500 INTUBATION ENDOTRACHEAL - ER SERV PROCED
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
8051020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.08 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: AlohaCare Medicaid |
$136.20
|
| Rate for Payer: AlohaCare Medicare |
$128.79
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Cash Price |
$252.20
|
| Rate for Payer: Devoted Health Medicare |
$141.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$119.08
|
| Rate for Payer: Health Management Network Commercial |
$329.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.79
|
|
|
31500 INTUBATION ENDOTRACHEAL - ER SERV PROCED
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
8051020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$986.00 |
| Max. Negotiated Rate |
$1,125.20 |
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Health Management Network Commercial |
$986.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,044.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,125.20
|
|
|
31502-Tracheotomy Tube Change
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
8080234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,118.60 |
| Max. Negotiated Rate |
$1,276.52 |
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
|
|
31502-Tracheotomy Tube Change
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 31502
|
| Hospital Charge Code |
8080234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$658.00
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Devoted Health Medicare |
$723.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$658.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,250.20
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Humana Medicare |
$658.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$658.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$658.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$658.00
|
| Rate for Payer: University Health Alliance Commercial |
$959.23
|
|
|
31505-Indirect Laryngoscopy
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
8080237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$528.00
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Devoted Health Medicare |
$580.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$528.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,003.20
|
| Rate for Payer: Health Management Network Commercial |
$897.60
|
| Rate for Payer: Humana Medicare |
$528.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$950.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$528.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,024.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$528.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$528.00
|
| Rate for Payer: University Health Alliance Commercial |
$769.72
|
|
|
31505-Indirect Laryngoscopy
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
8080237
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$1,024.32 |
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Health Management Network Commercial |
$897.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$950.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,024.32
|
|
|
31525-Direct Laryngoscopy Diagnostic
|
Facility
|
OP
|
$4,064.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
8080239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$2,032.00
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Devoted Health Medicare |
$2,235.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,032.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,860.80
|
| Rate for Payer: Health Management Network Commercial |
$3,454.40
|
| Rate for Payer: Humana Medicare |
$2,032.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,657.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,032.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,942.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,032.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,032.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,032.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
31525-Direct Laryngoscopy Diagnostic
|
Facility
|
IP
|
$4,064.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
8080239
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,454.40 |
| Max. Negotiated Rate |
$3,942.08 |
| Rate for Payer: Cash Price |
$2,641.60
|
| Rate for Payer: Health Management Network Commercial |
$3,454.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,657.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,942.08
|
|
|
31525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN TechFee
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
8211216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,782.10 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$2,465.00
|
| Rate for Payer: Cash Price |
$3,204.50
|
| Rate for Payer: Cash Price |
$3,204.50
|
| Rate for Payer: Devoted Health Medicare |
$2,711.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,465.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,683.50
|
| Rate for Payer: Health Management Network Commercial |
$4,190.50
|
| Rate for Payer: Humana Medicare |
$2,465.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,437.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,465.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,782.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,465.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,465.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,465.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
31525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN TechFee
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
8211216
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,190.50 |
| Max. Negotiated Rate |
$4,782.10 |
| Rate for Payer: Cash Price |
$3,204.50
|
| Rate for Payer: Health Management Network Commercial |
$4,190.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,437.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,782.10
|
|
|
31530 Laryngoscopy w Fb Removal Tech Fee
|
Facility
|
IP
|
$5,570.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
8343972
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,734.50 |
| Max. Negotiated Rate |
$5,402.90 |
| Rate for Payer: Cash Price |
$3,620.50
|
| Rate for Payer: Health Management Network Commercial |
$4,734.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,013.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,402.90
|
|
|
31530 Laryngoscopy w Fb Removal Tech Fee
|
Facility
|
OP
|
$5,570.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
8343972
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$901.48
|
| Rate for Payer: AlohaCare Medicare |
$2,785.00
|
| Rate for Payer: Cash Price |
$3,620.50
|
| Rate for Payer: Cash Price |
$3,620.50
|
| Rate for Payer: Devoted Health Medicare |
$3,063.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,785.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,291.50
|
| Rate for Payer: Health Management Network Commercial |
$4,734.50
|
| Rate for Payer: Humana Medicare |
$2,785.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,013.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,785.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,402.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,785.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,785.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,785.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
31530 - Laryngoscopy w/foreign removal
|
Facility
|
IP
|
$4,576.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
10498925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,889.60 |
| Max. Negotiated Rate |
$4,438.72 |
| Rate for Payer: Cash Price |
$2,974.40
|
| Rate for Payer: Health Management Network Commercial |
$3,889.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,118.40
|
| Rate for Payer: MDX Hawaii PPO |
$4,438.72
|
|
|
31530 - Laryngoscopy w/foreign removal
|
Facility
|
OP
|
$4,576.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
10498925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$901.48
|
| Rate for Payer: AlohaCare Medicare |
$2,288.00
|
| Rate for Payer: Cash Price |
$2,974.40
|
| Rate for Payer: Cash Price |
$2,974.40
|
| Rate for Payer: Devoted Health Medicare |
$2,516.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,288.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,347.20
|
| Rate for Payer: Health Management Network Commercial |
$3,889.60
|
| Rate for Payer: Humana Medicare |
$2,288.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,118.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,288.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,438.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,288.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,288.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,288.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
31575-Laryngoscopy Flexible Diagnostic
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
8080240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$251.00
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Devoted Health Medicare |
$276.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$251.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$476.90
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Humana Medicare |
$251.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.00
|
| Rate for Payer: MDX Hawaii PPO |
$486.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$251.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$251.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$251.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
31575-Laryngoscopy Flexible Diagnostic
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
8080240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$486.94 |
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.80
|
| Rate for Payer: MDX Hawaii PPO |
$486.94
|
|
|
31577 LARGSC W/RMVL FOREIGN BDY(S)
|
Facility
|
IP
|
$2,232.00
|
|
|
Service Code
|
HCPCS 31577
|
| Hospital Charge Code |
9227449
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,897.20 |
| Max. Negotiated Rate |
$2,165.04 |
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Health Management Network Commercial |
$1,897.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,008.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,165.04
|
|
|
31577 LARGSC W/RMVL FOREIGN BDY(S)
|
Facility
|
OP
|
$2,232.00
|
|
|
Service Code
|
HCPCS 31577
|
| Hospital Charge Code |
9227449
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$525.09 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Cash Price |
$1,450.80
|
| Rate for Payer: Devoted Health Medicare |
$1,227.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,116.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,120.40
|
| Rate for Payer: Health Management Network Commercial |
$1,897.20
|
| Rate for Payer: Humana Medicare |
$1,116.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,008.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,116.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,165.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,116.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,116.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,116.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,626.90
|
|
|
31603-Tracheostomy Transtracheal
|
Facility
|
IP
|
$6,688.00
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
8080183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,684.80 |
| Max. Negotiated Rate |
$6,487.36 |
| Rate for Payer: Cash Price |
$4,347.20
|
| Rate for Payer: Health Management Network Commercial |
$5,684.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,019.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,487.36
|
|
|
31603-Tracheostomy Transtracheal
|
Facility
|
OP
|
$6,688.00
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
8080183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,487.36 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$3,344.00
|
| Rate for Payer: Cash Price |
$4,347.20
|
| Rate for Payer: Cash Price |
$4,347.20
|
| Rate for Payer: Devoted Health Medicare |
$3,678.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,344.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,353.60
|
| Rate for Payer: Health Management Network Commercial |
$5,684.80
|
| Rate for Payer: Humana Medicare |
$3,344.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,019.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,344.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,487.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,344.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,344.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,344.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
32405 US Biopsy Lung Mediastinum Charges
|
Facility
|
OP
|
$7,195.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
8221514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,979.15 |
| Rate for Payer: AlohaCare Medicaid |
$3,597.50
|
| Rate for Payer: AlohaCare Medicare |
$3,597.50
|
| Rate for Payer: Cash Price |
$4,676.75
|
| Rate for Payer: Cash Price |
$4,676.75
|
| Rate for Payer: Devoted Health Medicare |
$3,957.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,655.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,597.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,835.25
|
| Rate for Payer: Health Management Network Commercial |
$6,115.75
|
| Rate for Payer: Humana Medicare |
$3,597.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,475.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,669.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,597.50
|
| Rate for Payer: MDX Hawaii PPO |
$6,979.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,597.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,597.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,597.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
32405 US Biopsy Lung Mediastinum Charges
|
Facility
|
IP
|
$7,195.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
8221514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,115.75 |
| Max. Negotiated Rate |
$6,979.15 |
| Rate for Payer: Cash Price |
$4,676.75
|
| Rate for Payer: Health Management Network Commercial |
$6,115.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,475.50
|
| Rate for Payer: MDX Hawaii PPO |
$6,979.15
|
|
|
32405 XA Biopsy Lung Mediastinum Charges
|
Facility
|
IP
|
$7,195.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
8221515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,115.75 |
| Max. Negotiated Rate |
$6,979.15 |
| Rate for Payer: Cash Price |
$4,676.75
|
| Rate for Payer: Health Management Network Commercial |
$6,115.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,475.50
|
| Rate for Payer: MDX Hawaii PPO |
$6,979.15
|
|
