|
59841 INDUCED ABORTION, BY DILATION AND EVACUATION ProFee
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59841
|
| Hospital Charge Code |
8021204
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$324.41 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$370.89
|
| Rate for Payer: AlohaCare Medicare |
$324.41
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$356.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$370.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$387.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$324.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$370.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.52
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$356.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$324.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$370.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$324.41
|
| Rate for Payer: University Health Alliance Commercial |
$491.55
|
|
|
59855 Induced abortion, by vaginal suppositories with or without cervical dilation
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 59855
|
| Hospital Charge Code |
8040037
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: AlohaCare Medicaid |
$423.51
|
| Rate for Payer: AlohaCare Medicare |
$372.48
|
| Rate for Payer: Cash Price |
$750.75
|
| Rate for Payer: Cash Price |
$750.75
|
| Rate for Payer: Devoted Health Medicare |
$409.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$372.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$395.98
|
| Rate for Payer: Health Management Network Commercial |
$981.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$409.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$409.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$409.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$423.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$372.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$423.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$372.48
|
|
|
59856 Induced abortion, by vaginal suppositories; with dilation and curettage and/or evacuation
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 59856
|
| Hospital Charge Code |
8040038
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$370.24 |
| Max. Negotiated Rate |
$1,150.05 |
| Rate for Payer: AlohaCare Medicaid |
$492.31
|
| Rate for Payer: AlohaCare Medicare |
$430.34
|
| Rate for Payer: Cash Price |
$879.45
|
| Rate for Payer: Cash Price |
$879.45
|
| Rate for Payer: Devoted Health Medicare |
$473.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$430.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.24
|
| Rate for Payer: Health Management Network Commercial |
$1,150.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$473.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$473.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$473.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$430.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$492.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$430.34
|
|
|
59870 Uterine evacuation and curettage for hydatidiform mole
|
Professional
|
Both
|
$4,505.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
8040039
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$286.78 |
| Max. Negotiated Rate |
$3,829.25 |
| Rate for Payer: AlohaCare Medicaid |
$552.27
|
| Rate for Payer: AlohaCare Medicare |
$481.23
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Cash Price |
$2,928.25
|
| Rate for Payer: Devoted Health Medicare |
$529.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$481.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.78
|
| Rate for Payer: Health Management Network Commercial |
$3,829.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$529.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$529.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$529.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$552.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$481.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$552.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$481.23
|
|
|
59899 - Hemorrhage control Bakri balloon
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
11738450
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Health Management Network Commercial |
$255.00
|
|
|
59899 Unlisted procedure, maternity care and delivery:
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
12139511
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$1,092.25 |
| Max. Negotiated Rate |
$1,092.25 |
| Rate for Payer: Cash Price |
$835.25
|
| Rate for Payer: Health Management Network Commercial |
$1,092.25
|
|
|
61500 Craniectomy; with excision of tumor or other bone lesion of skull
|
Professional
|
Both
|
$3,508.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
8040070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,981.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,299.43
|
| Rate for Payer: AlohaCare Medicare |
$1,173.61
|
| Rate for Payer: Cash Price |
$2,280.20
|
| Rate for Payer: Cash Price |
$2,280.20
|
| Rate for Payer: Devoted Health Medicare |
$1,290.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,173.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,457.30
|
| Rate for Payer: Health Management Network Commercial |
$2,981.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,290.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,290.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,290.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,299.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,173.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,299.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,173.61
|
|
|
62270-Lumbar Puncture Diagnostic
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8080238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$696.50
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Devoted Health Medicare |
$766.15
|
| 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 |
$696.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,323.35
|
| Rate for Payer: Health Management Network Commercial |
$1,184.05
|
| Rate for Payer: Humana Medicare |
$696.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,253.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$696.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,351.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$696.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$696.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$696.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
62270-Lumbar Puncture Diagnostic
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8080238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,184.05 |
| Max. Negotiated Rate |
$1,351.21 |
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Health Management Network Commercial |
$1,184.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,253.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,351.21
|
|
|
62270 SPINAL PUNCTURE LUMBAR ER SERV PROCEDURE
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8051075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$513.40 |
| Rate for Payer: AlohaCare Medicaid |
$61.33
|
| Rate for Payer: AlohaCare Medicare |
$55.99
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Devoted Health Medicare |
$61.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$113.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.68
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.99
|
| Rate for Payer: University Health Alliance Commercial |
$82.47
|
|
|
62270 SPINAL TAP CHARGE
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8279068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$956.25 |
| Max. Negotiated Rate |
$1,091.25 |
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,091.25
|
|
|
62270 SPINAL TAP CHARGE
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
8279068
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$562.50
|
| Rate for Payer: AlohaCare Medicare |
$562.50
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Devoted Health Medicare |
$618.75
|
| 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 |
$562.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$956.25
|
| Rate for Payer: Humana Medicare |
$562.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,012.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$562.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,091.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$562.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$562.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$562.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
62273 Epideral, blood patch
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
9350486
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$113.92
|
| Rate for Payer: AlohaCare Medicare |
$102.69
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Devoted Health Medicare |
$112.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$113.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$189.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.69
|
| Rate for Payer: University Health Alliance Commercial |
$149.39
|
|
|
62273-Inject Epidural Blood/Clot Patch
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
8080241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,524.90 |
| Max. Negotiated Rate |
$1,740.18 |
| Rate for Payer: Cash Price |
$1,166.10
|
| Rate for Payer: Health Management Network Commercial |
$1,524.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,614.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,740.18
|
|
|
62273-Inject Epidural Blood/Clot Patch
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS 62273
|
| Hospital Charge Code |
8080241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$672.48
|
| Rate for Payer: AlohaCare Medicare |
$897.00
|
| Rate for Payer: Cash Price |
$1,166.10
|
| Rate for Payer: Cash Price |
$1,166.10
|
| Rate for Payer: Devoted Health Medicare |
$986.70
|
| 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 |
$897.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,704.30
|
| Rate for Payer: Health Management Network Commercial |
$1,524.90
|
| Rate for Payer: Humana Medicare |
$897.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,614.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$897.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,740.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$897.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$897.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$897.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
62322 Inj Spine Lumb Sacr Caudal Charge
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
8141331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,037.00 |
| Max. Negotiated Rate |
$1,183.40 |
| Rate for Payer: Cash Price |
$793.00
|
| Rate for Payer: Health Management Network Commercial |
$1,037.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,098.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,183.40
|
|
|
62322 Inj Spine Lumb Sacr Caudal Charge
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
8141331
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$610.00
|
| Rate for Payer: AlohaCare Medicare |
$610.00
|
| Rate for Payer: Cash Price |
$793.00
|
| Rate for Payer: Cash Price |
$793.00
|
| Rate for Payer: Devoted Health Medicare |
$671.00
|
| 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 |
$610.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$1,037.00
|
| Rate for Payer: Humana Medicare |
$610.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,098.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$610.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,183.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$610.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$610.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$610.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
62323 EPIDUROGRAPY RS&I ProFee
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
8102706
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$100.76
|
| Rate for Payer: AlohaCare Medicare |
$90.18
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Devoted Health Medicare |
$99.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$100.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$167.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$100.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$273.26
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.18
|
| Rate for Payer: University Health Alliance Commercial |
$125.06
|
|
|
62326 Inject Spine w Cath L S Caud w/out Imag Charge
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
8141332
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,016.70 |
| Rate for Payer: AlohaCare Medicaid |
$1,555.00
|
| Rate for Payer: AlohaCare Medicare |
$1,555.00
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Devoted Health Medicare |
$1,710.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,129.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,555.00
|
| Rate for Payer: Health Management Network Commercial |
$2,643.50
|
| Rate for Payer: Humana Medicare |
$1,555.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,799.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,555.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,016.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,555.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,555.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,555.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,266.88
|
|
|
62326 Inject Spine w Cath L S Caud w/out Imag Charge
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
8141332
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,643.50 |
| Max. Negotiated Rate |
$3,016.70 |
| Rate for Payer: Cash Price |
$2,021.50
|
| Rate for Payer: Health Management Network Commercial |
$2,643.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,799.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,016.70
|
|
|
64400-Injection Nerve Block Trigeminal
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
8080178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$942.65 |
| Max. Negotiated Rate |
$1,075.73 |
| Rate for Payer: Cash Price |
$720.85
|
| Rate for Payer: Health Management Network Commercial |
$942.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$998.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,075.73
|
|
|
64400-Injection Nerve Block Trigeminal
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS 64400
|
| Hospital Charge Code |
8080178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$554.50
|
| Rate for Payer: Cash Price |
$720.85
|
| Rate for Payer: Cash Price |
$720.85
|
| Rate for Payer: Cash Price |
$720.85
|
| Rate for Payer: Devoted Health Medicare |
$609.95
|
| 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 |
$554.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,053.55
|
| Rate for Payer: Health Management Network Commercial |
$942.65
|
| Rate for Payer: Humana Medicare |
$554.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$998.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$554.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,075.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$554.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$554.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$554.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee
|
Facility
|
IP
|
$1,992.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
8211345
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,693.20 |
| Max. Negotiated Rate |
$1,932.24 |
| Rate for Payer: Cash Price |
$1,294.80
|
| Rate for Payer: Health Management Network Commercial |
$1,693.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,792.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,932.24
|
|
|
64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee
|
Facility
|
OP
|
$1,992.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
8211345
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,932.24 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$996.00
|
| Rate for Payer: Cash Price |
$1,294.80
|
| Rate for Payer: Cash Price |
$1,294.80
|
| Rate for Payer: Cash Price |
$1,294.80
|
| Rate for Payer: Devoted Health Medicare |
$1,095.60
|
| 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 |
$996.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,892.40
|
| Rate for Payer: Health Management Network Commercial |
$1,693.20
|
| Rate for Payer: Humana Medicare |
$996.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,792.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$996.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,932.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$996.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$996.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$996.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,451.97
|
|
|
64405-Inject Nerve Block Great Occipital
|
Facility
|
OP
|
$1,714.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
8080181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,662.58 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$857.00
|
| Rate for Payer: Cash Price |
$1,114.10
|
| Rate for Payer: Cash Price |
$1,114.10
|
| Rate for Payer: Cash Price |
$1,114.10
|
| Rate for Payer: Devoted Health Medicare |
$942.70
|
| 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 |
$857.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,628.30
|
| Rate for Payer: Health Management Network Commercial |
$1,456.90
|
| Rate for Payer: Humana Medicare |
$857.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,542.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$857.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,662.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$857.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$857.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$857.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,249.33
|
|
