|
49623 Removal of total or near total non-infected mesh or other
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 49623
|
| Hospital Charge Code |
11780246
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$243.10 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: AlohaCare Medicaid |
$190.83
|
| Rate for Payer: AlohaCare Medicare |
$174.80
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Devoted Health Medicare |
$192.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.80
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$190.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.80
|
|
|
49650 Laparoscopy, surgical; repair initial inguinal hernia
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
8039605
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.58 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: AlohaCare Medicaid |
$438.75
|
| Rate for Payer: AlohaCare Medicare |
$423.56
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Cash Price |
$754.00
|
| Rate for Payer: Devoted Health Medicare |
$465.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$398.58
|
| Rate for Payer: Health Management Network Commercial |
$986.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$465.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$465.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$465.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$438.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$438.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.56
|
|
|
49653 Laparoscopy, surgical, repair, vent/umbil/spige/epigas hernia; incarcerated or strangulated
|
Professional
|
Both
|
$9,010.00
|
|
|
Service Code
|
HCPCS 49593
|
| Hospital Charge Code |
8039608
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$502.59 |
| Max. Negotiated Rate |
$7,658.50 |
| Rate for Payer: AlohaCare Medicaid |
$554.95
|
| Rate for Payer: AlohaCare Medicare |
$502.59
|
| Rate for Payer: Cash Price |
$5,856.50
|
| Rate for Payer: Cash Price |
$5,856.50
|
| Rate for Payer: Devoted Health Medicare |
$552.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$502.59
|
| Rate for Payer: Health Management Network Commercial |
$7,658.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$552.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$552.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$552.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$554.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$502.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$554.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$502.59
|
|
|
49659 UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY ProFee
|
Professional
|
Both
|
$8,414.00
|
|
|
Service Code
|
HCPCS 49659
|
| Hospital Charge Code |
8020446
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$7,151.90 |
| Max. Negotiated Rate |
$7,151.90 |
| Rate for Payer: Cash Price |
$5,469.10
|
| Rate for Payer: Health Management Network Commercial |
$7,151.90
|
|
|
49999 ABDOMINAL WALL SUTURE
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 49999
|
| Hospital Charge Code |
8051056
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$695.22 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: AlohaCare Medicaid |
$695.22
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Cash Price |
$668.85
|
| Rate for Payer: Health Management Network Commercial |
$874.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$695.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$695.22
|
|
|
50200 CT Biopsy Renal
|
Facility
|
IP
|
$3,181.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
9882977
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,703.85 |
| Max. Negotiated Rate |
$3,085.57 |
| Rate for Payer: Cash Price |
$2,067.65
|
| Rate for Payer: Health Management Network Commercial |
$2,703.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,862.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,085.57
|
|
|
50200 CT Biopsy Renal
|
Facility
|
OP
|
$3,181.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
9882977
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$1,590.50
|
| Rate for Payer: Cash Price |
$2,067.65
|
| Rate for Payer: Cash Price |
$2,067.65
|
| Rate for Payer: Devoted Health Medicare |
$1,749.55
|
| 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 |
$1,590.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,021.95
|
| Rate for Payer: Health Management Network Commercial |
$2,703.85
|
| Rate for Payer: Humana Medicare |
$1,590.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,862.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,622.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,590.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,085.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,590.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,590.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,590.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,318.63
|
|
|
50200 Renal biopsy; percutaneous, by trocar or needle
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
8039623
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$125.78
|
| Rate for Payer: AlohaCare Medicare |
$110.23
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$121.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.88
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.23
|
|
|
50200 RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE ProFee
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
8020467
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$110.23 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$125.78
|
| Rate for Payer: AlohaCare Medicare |
$110.23
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$121.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$212.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.88
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.23
|
|
|
50200 US Biopsy Kidney
|
Facility
|
IP
|
$3,181.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
9887446
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,703.85 |
| Max. Negotiated Rate |
$3,085.57 |
| Rate for Payer: Cash Price |
$2,067.65
|
| Rate for Payer: Health Management Network Commercial |
$2,703.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,862.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,085.57
|
|
|
50200 US Biopsy Kidney
|
Facility
|
OP
|
$3,181.00
|
|
|
Service Code
|
HCPCS 50200
|
| Hospital Charge Code |
9887446
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$1,590.50
|
| Rate for Payer: Cash Price |
$2,067.65
|
| Rate for Payer: Cash Price |
$2,067.65
|
| Rate for Payer: Devoted Health Medicare |
$1,749.55
|
| 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 |
$1,590.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,021.95
|
| Rate for Payer: Health Management Network Commercial |
$2,703.85
|
| Rate for Payer: Humana Medicare |
$1,590.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,862.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,622.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,590.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,085.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,590.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,590.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,590.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,318.63
|
|
|
51100 Drain Bladder By Needle TechFee
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 51100
|
| Hospital Charge Code |
8343981
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$871.25 |
| Max. Negotiated Rate |
$994.25 |
| Rate for Payer: Cash Price |
$666.25
|
| Rate for Payer: Health Management Network Commercial |
$871.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$922.50
|
| Rate for Payer: MDX Hawaii PPO |
$994.25
|
|
|
51100 Drain Bladder By Needle TechFee
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 51100
|
| Hospital Charge Code |
8343981
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$512.50 |
| Max. Negotiated Rate |
$5,655.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$512.50
|
| Rate for Payer: Cash Price |
$666.25
|
| Rate for Payer: Cash Price |
$666.25
|
| Rate for Payer: Cash Price |
$666.25
|
| Rate for Payer: Devoted Health Medicare |
$563.75
|
| 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 |
$512.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$973.75
|
| Rate for Payer: Health Management Network Commercial |
$871.25
|
| Rate for Payer: Humana Medicare |
$512.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$922.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$512.50
|
| Rate for Payer: MDX Hawaii PPO |
$994.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$512.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$512.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$512.50
|
| Rate for Payer: University Health Alliance Commercial |
$747.12
|
|
|
51102 Aspiration of bladder; with insertion of suprapubic catheter
|
Professional
|
Both
|
$5,186.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
8039660
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.99 |
| Max. Negotiated Rate |
$4,408.10 |
| Rate for Payer: AlohaCare Medicaid |
$141.94
|
| Rate for Payer: AlohaCare Medicare |
$124.99
|
| Rate for Payer: Cash Price |
$3,370.90
|
| Rate for Payer: Cash Price |
$3,370.90
|
| Rate for Payer: Devoted Health Medicare |
$137.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$381.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.24
|
| Rate for Payer: Health Management Network Commercial |
$4,408.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.99
|
| Rate for Payer: University Health Alliance Commercial |
$189.74
|
|
|
51102 Drain Bl w Cath Insertion TechFee
|
Facility
|
OP
|
$10,424.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
8343982
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,111.28 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$5,212.00
|
| Rate for Payer: Cash Price |
$6,775.60
|
| Rate for Payer: Cash Price |
$6,775.60
|
| Rate for Payer: Cash Price |
$6,775.60
|
| Rate for Payer: Devoted Health Medicare |
$5,733.20
|
| 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 |
$5,212.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,902.80
|
| Rate for Payer: Health Management Network Commercial |
$8,860.40
|
| Rate for Payer: Humana Medicare |
$5,212.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,381.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,212.00
|
| Rate for Payer: MDX Hawaii PPO |
$10,111.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,212.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,212.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,212.00
|
| Rate for Payer: University Health Alliance Commercial |
$7,598.05
|
|
|
51102 Drain Bl w Cath Insertion TechFee
|
Facility
|
IP
|
$10,424.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
8343982
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8,860.40 |
| Max. Negotiated Rate |
$10,111.28 |
| Rate for Payer: Cash Price |
$6,775.60
|
| Rate for Payer: Health Management Network Commercial |
$8,860.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,381.60
|
| Rate for Payer: MDX Hawaii PPO |
$10,111.28
|
|
|
51610 Injection procedure for retrograde urethrocystography
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
8039672
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$287.30 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$58.80
|
| Rate for Payer: Cash Price |
$219.70
|
| Rate for Payer: Cash Price |
$219.70
|
| Rate for Payer: Devoted Health Medicare |
$64.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$107.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$287.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.80
|
| Rate for Payer: University Health Alliance Commercial |
$85.04
|
|
|
51610 XR INJ URETHROCYSTOGRAM RETRO
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
10073207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$708.10 |
| Rate for Payer: AlohaCare Medicaid |
$365.00
|
| Rate for Payer: AlohaCare Medicare |
$365.00
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Devoted Health Medicare |
$401.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$365.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$693.50
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Humana Medicare |
$365.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$372.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$365.00
|
| Rate for Payer: MDX Hawaii PPO |
$708.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$365.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$365.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$365.00
|
| Rate for Payer: University Health Alliance Commercial |
$532.10
|
|
|
51610 XR INJ URETHROCYSTOGRAM RETRO
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
10073207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.50 |
| Max. Negotiated Rate |
$708.10 |
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Health Management Network Commercial |
$620.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$657.00
|
| Rate for Payer: MDX Hawaii PPO |
$708.10
|
|
|
51700 BLADDER IRRIGATION
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8051057
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$221.85 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$25.62
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Devoted Health Medicare |
$28.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$69.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.64
|
| Rate for Payer: Health Management Network Commercial |
$221.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.62
|
| Rate for Payer: University Health Alliance Commercial |
$39.85
|
|
|
51700 Bladder irrigation and/or instillation
|
Facility
|
OP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8890098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$827.50
|
| Rate for Payer: AlohaCare Medicare |
$827.50
|
| Rate for Payer: Cash Price |
$1,075.75
|
| Rate for Payer: Cash Price |
$1,075.75
|
| Rate for Payer: Cash Price |
$1,075.75
|
| Rate for Payer: Devoted Health Medicare |
$910.25
|
| 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 |
$827.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,572.25
|
| Rate for Payer: Health Management Network Commercial |
$1,406.75
|
| Rate for Payer: Humana Medicare |
$827.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,489.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$844.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$827.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,605.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$827.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$827.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$827.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,206.33
|
|
|
51700 Bladder irrigation and/or instillation
|
Facility
|
IP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8890098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,406.75 |
| Max. Negotiated Rate |
$1,605.35 |
| Rate for Payer: Cash Price |
$1,075.75
|
| Rate for Payer: Health Management Network Commercial |
$1,406.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,489.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,605.35
|
|
|
51700-Bladder Irrigation Simple Lavage/Instill
|
Facility
|
OP
|
$1,473.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8080221
|
|
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 |
$736.50
|
| Rate for Payer: Cash Price |
$957.45
|
| Rate for Payer: Cash Price |
$957.45
|
| Rate for Payer: Cash Price |
$957.45
|
| Rate for Payer: Devoted Health Medicare |
$810.15
|
| 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 |
$736.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,399.35
|
| Rate for Payer: Health Management Network Commercial |
$1,252.05
|
| Rate for Payer: Humana Medicare |
$736.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,325.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$736.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,428.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$736.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$736.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$736.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,073.67
|
|
|
51700-Bladder Irrigation Simple Lavage/Instill
|
Facility
|
IP
|
$1,473.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
8080221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,252.05 |
| Max. Negotiated Rate |
$1,428.81 |
| Rate for Payer: Cash Price |
$957.45
|
| Rate for Payer: Health Management Network Commercial |
$1,252.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,325.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,428.81
|
|
|
51701-Insert Bladder Cath Non-Dwelling
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
8080223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.85 |
| Max. Negotiated Rate |
$388.97 |
| Rate for Payer: Cash Price |
$260.65
|
| Rate for Payer: Health Management Network Commercial |
$340.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.90
|
| Rate for Payer: MDX Hawaii PPO |
$388.97
|
|
