|
36593 DECLOT PICC, CVC, etc.
|
Facility
|
IP
|
$1,428.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
8518811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,213.80 |
| Max. Negotiated Rate |
$1,385.16 |
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Health Management Network Commercial |
$1,213.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,285.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,385.16
|
|
|
36593 DECLOT PICC, CVC, etc.
|
Facility
|
OP
|
$1,428.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
8518811
|
|
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 |
$714.00
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$714.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,356.60
|
| Rate for Payer: Health Management Network Commercial |
$1,213.80
|
| Rate for Payer: Humana Medicare |
$714.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,285.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$714.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,385.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$714.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$714.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$714.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,040.87
|
|
|
36593 Declot Vascular Device Charges
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
8221488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,073.55 |
| Max. Negotiated Rate |
$1,225.11 |
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Health Management Network Commercial |
$1,073.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,136.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,225.11
|
|
|
36593 Declot Vascular Device Charges
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
8221488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$631.50
|
| Rate for Payer: AlohaCare Medicare |
$631.50
|
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Devoted Health Medicare |
$694.65
|
| 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 |
$631.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,199.85
|
| Rate for Payer: Health Management Network Commercial |
$1,073.55
|
| Rate for Payer: Humana Medicare |
$631.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,136.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$644.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$631.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,225.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$631.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$631.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$631.50
|
| Rate for Payer: University Health Alliance Commercial |
$920.60
|
|
|
36600-Arterial Puncture
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8080201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: AlohaCare Medicaid |
$127.50
|
| Rate for Payer: AlohaCare Medicare |
$127.50
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Devoted Health Medicare |
$140.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.25
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Humana Medicare |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.50
|
| Rate for Payer: University Health Alliance Commercial |
$185.87
|
|
|
36600-Arterial Puncture
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8080201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
|
|
36600 ARTERIAL PUNCTURE (BLOOD GAS)
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8743028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: AlohaCare Medicaid |
$130.00
|
| Rate for Payer: AlohaCare Medicare |
$130.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Devoted Health Medicare |
$143.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Humana Medicare |
$130.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.00
|
| Rate for Payer: University Health Alliance Commercial |
$189.51
|
|
|
36600 ARTERIAL PUNCTURE (BLOOD GAS)
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8743028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
|
|
36600 ARTERIAL PUNCTURE FOR RESPIRATORY
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8051034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: AlohaCare Medicaid |
$14.85
|
| Rate for Payer: AlohaCare Medicare |
$13.02
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$14.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.02
|
| Rate for Payer: University Health Alliance Commercial |
$24.00
|
|
|
36600 BLD DRAW per RN from Arterial line
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8518809
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
|
|
36600 BLD DRAW per RN from Arterial line
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
8518809
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$130.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Devoted Health Medicare |
$143.00
|
| 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 |
$130.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Humana Medicare |
$130.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.00
|
| Rate for Payer: University Health Alliance Commercial |
$189.51
|
|
|
36620-Arterial Catheterization
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8080203
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$136.50
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Devoted Health Medicare |
$150.15
|
| 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 |
$136.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.35
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Humana Medicare |
$136.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.50
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.50
|
| Rate for Payer: University Health Alliance Commercial |
$198.99
|
|
|
36620-Arterial Catheterization
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8080203
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
36620 Arterial catheterization/cannulation for sampling, monitoring or transfusion; percutaneous
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8038975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
36620 Arterial catheterization/cannulation for sampling, monitoring or transfusion; percutaneous
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
8038975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$92.00
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$101.20
|
| 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 |
$92.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$92.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.00
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.00
|
| Rate for Payer: University Health Alliance Commercial |
$134.12
|
|
|
36640 Central Line Cath Cutdown Charges
|
Facility
|
OP
|
$12,562.00
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
8221484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$12,185.14 |
| Rate for Payer: Devoted Health Medicare |
$6,909.10
|
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$6,281.00
|
| Rate for Payer: Cash Price |
$8,165.30
|
| Rate for Payer: Cash Price |
$8,165.30
|
| 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 |
$6,281.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,933.90
|
| Rate for Payer: Health Management Network Commercial |
$10,677.70
|
| Rate for Payer: Humana Medicare |
$6,281.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,305.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,406.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,281.00
|
| Rate for Payer: MDX Hawaii PPO |
$12,185.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,281.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,281.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,281.00
|
| Rate for Payer: University Health Alliance Commercial |
$9,156.44
|
|
|
36640 Central Line Cath Cutdown Charges
|
Facility
|
IP
|
$12,562.00
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
8221484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10,677.70 |
| Max. Negotiated Rate |
$12,185.14 |
| Rate for Payer: Cash Price |
$8,165.30
|
| Rate for Payer: Health Management Network Commercial |
$10,677.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,305.80
|
| Rate for Payer: MDX Hawaii PPO |
$12,185.14
|
|
|
36640 Central Line Cath Cutdown TechFee
|
Facility
|
OP
|
$14,553.00
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
8343974
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$14,116.41 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$7,276.50
|
| Rate for Payer: Cash Price |
$9,459.45
|
| Rate for Payer: Cash Price |
$9,459.45
|
| Rate for Payer: Devoted Health Medicare |
$8,004.15
|
| 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 |
$7,276.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,825.35
|
| Rate for Payer: Health Management Network Commercial |
$12,370.05
|
| Rate for Payer: Humana Medicare |
$7,276.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$13,097.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,276.50
|
| Rate for Payer: MDX Hawaii PPO |
$14,116.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,276.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,276.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,276.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,607.68
|
|
|
36640 Central Line Cath Cutdown TechFee
|
Facility
|
IP
|
$14,553.00
|
|
|
Service Code
|
HCPCS 36640
|
| Hospital Charge Code |
8343974
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$12,370.05 |
| Max. Negotiated Rate |
$14,116.41 |
| Rate for Payer: Cash Price |
$9,459.45
|
| Rate for Payer: Health Management Network Commercial |
$12,370.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$13,097.70
|
| Rate for Payer: MDX Hawaii PPO |
$14,116.41
|
|
|
36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION TechFee
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
8211313
|
|
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 |
$439.50
|
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Devoted Health Medicare |
$483.45
|
| 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 |
$439.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$835.05
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Humana Medicare |
$439.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$439.50
|
| Rate for Payer: MDX Hawaii PPO |
$852.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$439.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$439.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$439.50
|
| Rate for Payer: University Health Alliance Commercial |
$640.70
|
|
|
36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION TechFee
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
8211313
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$747.15 |
| Max. Negotiated Rate |
$852.63 |
| Rate for Payer: Cash Price |
$571.35
|
| Rate for Payer: Health Management Network Commercial |
$747.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$791.10
|
| Rate for Payer: MDX Hawaii PPO |
$852.63
|
|
|
36680-Place Needle Intraosseous Infusion
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
8080173
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.65 |
| Max. Negotiated Rate |
$784.73 |
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Health Management Network Commercial |
$687.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.10
|
| Rate for Payer: MDX Hawaii PPO |
$784.73
|
|
|
36680-Place Needle Intraosseous Infusion
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
8080173
|
|
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 |
$404.50
|
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Cash Price |
$525.85
|
| Rate for Payer: Devoted Health Medicare |
$444.95
|
| 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 |
$404.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$768.55
|
| Rate for Payer: Health Management Network Commercial |
$687.65
|
| Rate for Payer: Humana Medicare |
$404.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$404.50
|
| Rate for Payer: MDX Hawaii PPO |
$784.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$404.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$404.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$404.50
|
| Rate for Payer: University Health Alliance Commercial |
$589.68
|
|
|
38220 Bone Marrow Aspiration Bilat TechFee
|
Facility
|
IP
|
$4,222.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
8343975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,588.70 |
| Max. Negotiated Rate |
$4,095.34 |
| Rate for Payer: Cash Price |
$2,744.30
|
| Rate for Payer: Health Management Network Commercial |
$3,588.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,799.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,095.34
|
|
|
38220 Bone Marrow Aspiration Bilat TechFee
|
Facility
|
OP
|
$4,222.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
8343975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,095.34 |
| Rate for Payer: AlohaCare Medicaid |
$2,111.00
|
| Rate for Payer: AlohaCare Medicare |
$2,111.00
|
| Rate for Payer: Cash Price |
$2,744.30
|
| Rate for Payer: Cash Price |
$2,744.30
|
| Rate for Payer: Devoted Health Medicare |
$2,322.10
|
| 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 |
$2,111.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,010.90
|
| Rate for Payer: Health Management Network Commercial |
$3,588.70
|
| Rate for Payer: Humana Medicare |
$2,111.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,799.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,153.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,111.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,095.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,111.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,111.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,111.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,077.42
|
|
