|
36556 CENTRAL VENOUS CATHETER PLACE>2YR HOSP P
|
Facility
|
OP
|
$5,300.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
8051032
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,141.00 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$2,650.00
|
| Rate for Payer: Cash Price |
$3,445.00
|
| Rate for Payer: Cash Price |
$3,445.00
|
| Rate for Payer: Devoted Health Medicare |
$2,915.00
|
| 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 |
$2,650.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,035.00
|
| Rate for Payer: Health Management Network Commercial |
$4,505.00
|
| Rate for Payer: Humana Medicare |
$2,650.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,770.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,703.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,650.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,141.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,650.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,650.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,650.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,863.17
|
|
|
36556 CENTRAL VENOUS CATHETER PLACE>2YR HOSP P
|
Professional
|
Both
|
$4,394.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
8051032
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: AlohaCare Medicaid |
$82.05
|
| Rate for Payer: AlohaCare Medicare |
$75.99
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Devoted Health Medicare |
$83.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$183.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$317.46
|
| Rate for Payer: Health Management Network Commercial |
$3,734.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.99
|
|
|
36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee
|
Facility
|
IP
|
$5,752.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
8211304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,889.20 |
| Max. Negotiated Rate |
$5,579.44 |
| Rate for Payer: Cash Price |
$3,738.80
|
| Rate for Payer: Health Management Network Commercial |
$4,889.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,176.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,579.44
|
|
|
36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee
|
Facility
|
OP
|
$5,752.00
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
8211304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,579.44 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$2,876.00
|
| Rate for Payer: Cash Price |
$3,738.80
|
| Rate for Payer: Cash Price |
$3,738.80
|
| Rate for Payer: Devoted Health Medicare |
$3,163.60
|
| 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 |
$2,876.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,464.40
|
| Rate for Payer: Health Management Network Commercial |
$4,889.20
|
| Rate for Payer: Humana Medicare |
$2,876.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,176.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,876.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,579.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,876.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,876.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,876.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,192.63
|
|
|
36558 INSERTION OF TUNNEL CENTRAL CATH-ER PROC
|
Professional
|
Both
|
$2,493.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
8051033
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.89 |
| Max. Negotiated Rate |
$2,119.05 |
| Rate for Payer: AlohaCare Medicaid |
$256.53
|
| Rate for Payer: AlohaCare Medicare |
$231.89
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,620.45
|
| Rate for Payer: Devoted Health Medicare |
$255.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$434.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$256.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,012.44
|
| Rate for Payer: Health Management Network Commercial |
$2,119.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$255.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$255.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$231.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$231.89
|
|
|
36561 Insertion of tunneled centrally inserted central venous access device, w/sub port; age 5+
|
Professional
|
Both
|
$4,394.00
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
8038962
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: AlohaCare Medicaid |
$327.70
|
| Rate for Payer: AlohaCare Medicare |
$297.47
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Devoted Health Medicare |
$327.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$327.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$557.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$327.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,358.76
|
| Rate for Payer: Health Management Network Commercial |
$3,734.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$327.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$327.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$327.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$327.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$327.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.47
|
|
|
36568 Insert PICC Cath < 5 Yr w/out imaging Charges
|
Facility
|
OP
|
$3,339.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
8221516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,238.83 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$1,669.50
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Devoted Health Medicare |
$1,836.45
|
| 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 |
$1,669.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,172.05
|
| Rate for Payer: Health Management Network Commercial |
$2,838.15
|
| Rate for Payer: Humana Medicare |
$1,669.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,005.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,702.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,669.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,238.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,669.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,669.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,669.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,433.80
|
|
|
36568 Insert PICC Cath < 5 Yr w/out imaging Charges
|
Facility
|
IP
|
$3,339.00
|
|
|
Service Code
|
HCPCS 36568
|
| Hospital Charge Code |
8221516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,838.15 |
| Max. Negotiated Rate |
$3,238.83 |
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Health Management Network Commercial |
$2,838.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,005.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,238.83
|
|
|
36569-PICC Line Insertion Greater Than/Equal to 5 Years
|
Facility
|
IP
|
$3,286.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
8080197
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,793.10 |
| Max. Negotiated Rate |
$3,187.42 |
| Rate for Payer: Cash Price |
$2,135.90
|
| Rate for Payer: Health Management Network Commercial |
$2,793.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,957.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,187.42
|
|
|
36569-PICC Line Insertion Greater Than/Equal to 5 Years
|
Facility
|
OP
|
$3,286.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
8080197
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,187.42 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$1,643.00
|
| Rate for Payer: Cash Price |
$2,135.90
|
| Rate for Payer: Cash Price |
$2,135.90
|
| Rate for Payer: Devoted Health Medicare |
$1,807.30
|
| 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 |
$1,643.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,121.70
|
| Rate for Payer: Health Management Network Commercial |
$2,793.10
|
| Rate for Payer: Humana Medicare |
$1,643.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,957.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,643.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,187.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,643.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,643.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,643.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,395.17
|
|
|
36571 Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5
|
Professional
|
Both
|
$4,394.00
|
|
|
Service Code
|
HCPCS 36571
|
| Hospital Charge Code |
8118465
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: AlohaCare Medicaid |
$309.32
|
| Rate for Payer: AlohaCare Medicare |
$291.56
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Devoted Health Medicare |
$320.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$309.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$526.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$309.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,399.06
|
| Rate for Payer: Health Management Network Commercial |
$3,734.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$320.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$320.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$320.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$309.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$309.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.56
|
|
|
36573 INSERT CENTRAL VENOUS CATH. (INFUSION/IMAGING GUIDANCE) 5 YEARS OR > ProFee
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
10337354
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$71.08 |
| Max. Negotiated Rate |
$1,862.35 |
| Rate for Payer: AlohaCare Medicaid |
$81.56
|
| Rate for Payer: AlohaCare Medicare |
$71.08
|
| Rate for Payer: Cash Price |
$1,424.15
|
| Rate for Payer: Cash Price |
$1,424.15
|
| Rate for Payer: Devoted Health Medicare |
$78.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$148.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.92
|
| Rate for Payer: Health Management Network Commercial |
$1,862.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$81.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.08
|
| Rate for Payer: University Health Alliance Commercial |
$109.52
|
|
|
36573 INSERTION OF PICC, W/O SUBCUTANEOUS PORT OR PUMP TechFee
|
Facility
|
IP
|
$3,667.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
8703514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,116.95 |
| Max. Negotiated Rate |
$3,556.99 |
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Health Management Network Commercial |
$3,116.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,300.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,556.99
|
|
|
36573 INSERTION OF PICC, W/O SUBCUTANEOUS PORT OR PUMP TechFee
|
Facility
|
OP
|
$3,667.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
8703514
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$3,556.99 |
| Rate for Payer: AlohaCare Medicaid |
$1,833.50
|
| Rate for Payer: AlohaCare Medicare |
$1,833.50
|
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Cash Price |
$2,383.55
|
| Rate for Payer: Devoted Health Medicare |
$2,016.85
|
| 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 |
$1,833.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$3,116.95
|
| Rate for Payer: Humana Medicare |
$1,833.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,300.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,833.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,556.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,833.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,833.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,833.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,672.88
|
|
|
36573 INSERT PICC W/RS&I 5 YR/> CHARGE
|
Facility
|
OP
|
$3,014.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
9303846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,923.58 |
| Rate for Payer: AlohaCare Medicaid |
$1,507.00
|
| Rate for Payer: AlohaCare Medicare |
$1,507.00
|
| Rate for Payer: Cash Price |
$1,959.10
|
| Rate for Payer: Cash Price |
$1,959.10
|
| Rate for Payer: Devoted Health Medicare |
$1,657.70
|
| 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 |
$1,507.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$2,561.90
|
| Rate for Payer: Humana Medicare |
$1,507.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,712.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,507.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,923.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,507.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,507.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,507.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,196.90
|
|
|
36573 INSERT PICC W/RS&I 5 YR/> CHARGE
|
Facility
|
IP
|
$3,014.00
|
|
|
Service Code
|
HCPCS 36573
|
| Hospital Charge Code |
9303846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,561.90 |
| Max. Negotiated Rate |
$2,923.58 |
| Rate for Payer: Cash Price |
$1,959.10
|
| Rate for Payer: Health Management Network Commercial |
$2,561.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,712.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,923.58
|
|
|
36576 Repair of central venous access device, w/ subcutaneous port/pump, central/periph insert site
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 36576
|
| Hospital Charge Code |
8038965
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$170.08 |
| Max. Negotiated Rate |
$1,862.35 |
| Rate for Payer: AlohaCare Medicaid |
$181.70
|
| Rate for Payer: AlohaCare Medicare |
$170.08
|
| Rate for Payer: Cash Price |
$1,424.15
|
| Rate for Payer: Cash Price |
$1,424.15
|
| Rate for Payer: Devoted Health Medicare |
$187.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$309.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$181.70
|
| Rate for Payer: Health Management Network Commercial |
$1,862.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.08
|
| Rate for Payer: University Health Alliance Commercial |
$244.08
|
|
|
36591 Blood draw or Accessing charge from IMPLANTABLE PORT I.E. PORTACATH
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8743030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: AlohaCare Medicaid |
$243.50
|
| Rate for Payer: AlohaCare Medicare |
$243.50
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Devoted Health Medicare |
$267.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$462.65
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Humana Medicare |
$243.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.50
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.50
|
| Rate for Payer: University Health Alliance Commercial |
$354.97
|
|
|
36591 Blood draw or Accessing charge from IMPLANTABLE PORT I.E. PORTACATH
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8743030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
|
|
36591 Capillary Blood Draw (up to 6 per day)
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8743031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
|
|
36591 Capillary Blood Draw (up to 6 per day)
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8743031
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: AlohaCare Medicaid |
$243.50
|
| Rate for Payer: AlohaCare Medicare |
$243.50
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Devoted Health Medicare |
$267.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$462.65
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Humana Medicare |
$243.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.50
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.50
|
| Rate for Payer: University Health Alliance Commercial |
$354.97
|
|
|
36591-Collect Blood Port/Access Device
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8080199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$202.50
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Devoted Health Medicare |
$222.75
|
| 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 |
$202.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$384.75
|
| Rate for Payer: Health Management Network Commercial |
$344.25
|
| Rate for Payer: Humana Medicare |
$202.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$202.50
|
| Rate for Payer: MDX Hawaii PPO |
$392.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$202.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$202.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$202.50
|
| Rate for Payer: University Health Alliance Commercial |
$295.20
|
|
|
36591-Collect Blood Port/Access Device
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8080199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$392.85 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Health Management Network Commercial |
$344.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.50
|
| Rate for Payer: MDX Hawaii PPO |
$392.85
|
|
|
36592 BLD DRAW per RN Central line
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
8518810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$291.97 |
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.90
|
| Rate for Payer: MDX Hawaii PPO |
$291.97
|
|
|
36592 BLD DRAW per RN Central line
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
8518810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$291.97 |
| Rate for Payer: AlohaCare Medicaid |
$150.50
|
| Rate for Payer: AlohaCare Medicare |
$150.50
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Devoted Health Medicare |
$165.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$285.95
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Humana Medicare |
$150.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.50
|
| Rate for Payer: MDX Hawaii PPO |
$291.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.50
|
| Rate for Payer: University Health Alliance Commercial |
$219.40
|
|
