|
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
|
|
|
64415 NBlk Inj Brachial Plexus TechFee
|
Facility
|
IP
|
$2,128.00
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
8343984
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,808.80 |
| Max. Negotiated Rate |
$2,064.16 |
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Health Management Network Commercial |
$1,808.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,915.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,064.16
|
|
|
64415 NBlk Inj Brachial Plexus TechFee
|
Facility
|
OP
|
$2,128.00
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
8343984
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$1,064.00
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Devoted Health Medicare |
$1,170.40
|
| 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 |
$1,064.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,021.60
|
| Rate for Payer: Health Management Network Commercial |
$1,808.80
|
| Rate for Payer: Humana Medicare |
$1,064.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,915.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,064.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,064.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,064.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,064.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,064.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,551.10
|
|
|
64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH TechFee
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
8211346
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,872.55 |
| Max. Negotiated Rate |
$2,136.91 |
| Rate for Payer: Cash Price |
$1,431.95
|
| Rate for Payer: Health Management Network Commercial |
$1,872.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,982.70
|
| Rate for Payer: MDX Hawaii PPO |
$2,136.91
|
|
|
64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH TechFee
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
8211346
|
|
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 |
$1,101.50
|
| Rate for Payer: Cash Price |
$1,431.95
|
| Rate for Payer: Cash Price |
$1,431.95
|
| Rate for Payer: Cash Price |
$1,431.95
|
| Rate for Payer: Devoted Health Medicare |
$1,211.65
|
| 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 |
$1,101.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,092.85
|
| Rate for Payer: Health Management Network Commercial |
$1,872.55
|
| Rate for Payer: Humana Medicare |
$1,101.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,982.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,101.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,136.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,101.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,101.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,101.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
64450 Injection, anesthetic agent; other peripheral nerve or branch
|
Professional
|
Both
|
$1,044.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
8040179
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$887.40 |
| Rate for Payer: AlohaCare Medicaid |
$42.33
|
| Rate for Payer: AlohaCare Medicare |
$39.03
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Devoted Health Medicare |
$42.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$102.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$887.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.03
|
| Rate for Payer: University Health Alliance Commercial |
$52.25
|
|
|
64450-Injection Nerve Block Peripheral
|
Facility
|
OP
|
$1,883.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
8080180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: Kaiser Permanente Medicare |
$941.50
|
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$941.50
|
| Rate for Payer: Cash Price |
$1,223.95
|
| Rate for Payer: Cash Price |
$1,223.95
|
| Rate for Payer: Cash Price |
$1,223.95
|
| Rate for Payer: Devoted Health Medicare |
$1,035.65
|
| 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 |
$941.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,788.85
|
| Rate for Payer: Health Management Network Commercial |
$1,600.55
|
| Rate for Payer: Humana Medicare |
$941.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,694.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,826.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$941.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$941.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$941.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
64450-Injection Nerve Block Peripheral
|
Facility
|
IP
|
$1,883.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
8080180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,600.55 |
| Max. Negotiated Rate |
$1,826.51 |
| Rate for Payer: Cash Price |
$1,223.95
|
| Rate for Payer: Health Management Network Commercial |
$1,600.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,694.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,826.51
|
|
|
64455 NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE TechFee
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
8211347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Health Management Network Commercial |
$918.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$972.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,047.60
|
|
|
64455 NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE TechFee
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
8211347
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$540.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Devoted Health Medicare |
$594.00
|
| 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 |
$540.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network Commercial |
$918.00
|
| Rate for Payer: Humana Medicare |
$540.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$540.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,047.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$540.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$540.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$540.00
|
| Rate for Payer: University Health Alliance Commercial |
$787.21
|
|
|
64632 DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERVE ProFee
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 64632
|
| Hospital Charge Code |
8021676
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$63.09 |
| Max. Negotiated Rate |
$362.95 |
| Rate for Payer: AlohaCare Medicaid |
$68.82
|
| Rate for Payer: AlohaCare Medicare |
$63.09
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$69.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$112.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.09
|
| Rate for Payer: University Health Alliance Commercial |
$86.35
|
|
|
64772 Transection or avulsion of other spinal nerve, extradural
|
Professional
|
Both
|
$2,718.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
8040232
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$414.18 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: AlohaCare Medicaid |
$578.89
|
| Rate for Payer: AlohaCare Medicare |
$525.51
|
| Rate for Payer: Cash Price |
$1,766.70
|
| Rate for Payer: Cash Price |
$1,766.70
|
| Rate for Payer: Devoted Health Medicare |
$578.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$525.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$414.18
|
| Rate for Payer: Health Management Network Commercial |
$2,310.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$578.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$578.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$578.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$578.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$525.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$578.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$525.51
|
| Rate for Payer: University Health Alliance Commercial |
$787.00
|
|
|
65205-Conjuctival Superficial
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
8080138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$576.18 |
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.60
|
| Rate for Payer: MDX Hawaii PPO |
$576.18
|
|
|
65205-Conjuctival Superficial
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
8080138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$297.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Devoted Health Medicare |
$326.70
|
| 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 |
$297.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$564.30
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Humana Medicare |
$297.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.00
|
| Rate for Payer: MDX Hawaii PPO |
$576.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.00
|
| Rate for Payer: University Health Alliance Commercial |
$432.97
|
|
|
65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
8211348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
|
|
65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
8211348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$344.50
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Devoted Health Medicare |
$378.95
|
| 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 |
$344.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$654.55
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Humana Medicare |
$344.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$344.50
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$344.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$344.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$344.50
|
| Rate for Payer: University Health Alliance Commercial |
$502.21
|
|
|
65220-Corneal w/o Slit Lamp
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
8080140
|
|
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
|
|
|
65220-Corneal w/o Slit Lamp
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
8080140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$404.50 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$404.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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
|
|
|
65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP TechFee
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
8211350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.50 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 |
$588.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$439.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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
|
|
|
65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP TechFee
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
8211350
|
|
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
|
|
|
65222-Corneal w/ Slit Lamp
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
8080142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$576.18 |
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.60
|
| Rate for Payer: MDX Hawaii PPO |
$576.18
|
|
|
65222-Corneal w/ Slit Lamp
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
8080142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$7,085.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$297.00
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Cash Price |
$386.10
|
| Rate for Payer: Devoted Health Medicare |
$326.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,085.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$564.30
|
| Rate for Payer: Health Management Network Commercial |
$504.90
|
| Rate for Payer: Humana Medicare |
$297.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$534.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.00
|
| Rate for Payer: MDX Hawaii PPO |
$576.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.00
|
| Rate for Payer: University Health Alliance Commercial |
$432.97
|
|
|
65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP TechFee
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
8211351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
|
|
65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP TechFee
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
8211351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.50 |
| Max. Negotiated Rate |
$7,085.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$344.50
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Devoted Health Medicare |
$378.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,085.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$344.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$654.55
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Humana Medicare |
$344.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$344.50
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$344.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$344.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$344.50
|
| Rate for Payer: University Health Alliance Commercial |
$502.21
|
|
|
67343 Release of extensive scar tissue without detaching extraocular muscle (separate procedure)
|
Professional
|
Both
|
$3,309.00
|
|
|
Service Code
|
HCPCS 67343
|
| Hospital Charge Code |
8040394
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$399.88 |
| Max. Negotiated Rate |
$2,812.65 |
| Rate for Payer: AlohaCare Medicaid |
$710.77
|
| Rate for Payer: AlohaCare Medicare |
$612.41
|
| Rate for Payer: Cash Price |
$2,150.85
|
| Rate for Payer: Cash Price |
$2,150.85
|
| Rate for Payer: Devoted Health Medicare |
$673.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$612.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$399.88
|
| Rate for Payer: Health Management Network Commercial |
$2,812.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$673.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$673.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$673.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$612.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$710.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$612.41
|
|
