|
HCHG REMOVAL FOREIGN BODY INTRAOCCULAR
|
Facility
|
OP
|
$7,820.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
H4501119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,741.80 |
| Rate for Payer: AlohaCare Medicaid |
$3,910.00
|
| Rate for Payer: AlohaCare Medicare |
$7,038.00
|
| Rate for Payer: Cash Price |
$5,083.00
|
| Rate for Payer: Cash Price |
$5,083.00
|
| Rate for Payer: Devoted Health Medicare |
$7,741.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,038.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,429.00
|
| Rate for Payer: Health Management Network Commercial |
$6,647.00
|
| Rate for Payer: Humana Medicare |
$7,038.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,038.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,038.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,585.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,038.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,038.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,038.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG REMOVAL IMPACTED EAR WAX, UNILATERAL
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
H4501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
HCHG REMOVAL IMPACTED EAR WAX, UNILATERAL
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
H4501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$385.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$423.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$385.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.20
|
| Rate for Payer: University Health Alliance Commercial |
$311.97
|
|
|
HCHG REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
OP
|
$1,766.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
H4501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$883.00
|
| Rate for Payer: AlohaCare Medicare |
$1,589.40
|
| Rate for Payer: Cash Price |
$1,147.90
|
| Rate for Payer: Cash Price |
$1,147.90
|
| Rate for Payer: Devoted Health Medicare |
$1,748.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,589.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,677.70
|
| Rate for Payer: Health Management Network Commercial |
$1,501.10
|
| Rate for Payer: Humana Medicare |
$1,589.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,589.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,589.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,713.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,589.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,589.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,589.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG REMOVAL INTRAUTERINE DEVICE IUD
|
Facility
|
IP
|
$1,766.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
H4501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,501.10 |
| Max. Negotiated Rate |
$1,713.02 |
| Rate for Payer: Cash Price |
$1,147.90
|
| Rate for Payer: Health Management Network Commercial |
$1,501.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,589.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,713.02
|
|
|
HCHG REMOVAL OF FECAL IMPACT OR FB
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
H4501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,019.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,030.00
|
| Rate for Payer: AlohaCare Medicare |
$3,654.00
|
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Devoted Health Medicare |
$4,019.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,654.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,857.00
|
| Rate for Payer: Health Management Network Commercial |
$3,451.00
|
| Rate for Payer: Humana Medicare |
$3,654.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,654.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,654.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,938.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,654.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,654.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,654.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,959.33
|
|
|
HCHG REMOVAL OF FECAL IMPACT OR FB
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
H4501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,451.00 |
| Max. Negotiated Rate |
$3,938.20 |
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Health Management Network Commercial |
$3,451.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,654.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,938.20
|
|
|
HCHG REMOVAL OF FOREIGN BODY - SIMPLE
|
Facility
|
IP
|
$5,612.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
H4500927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,770.20 |
| Max. Negotiated Rate |
$5,443.64 |
| Rate for Payer: Cash Price |
$3,647.80
|
| Rate for Payer: Health Management Network Commercial |
$4,770.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,050.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,443.64
|
|
|
HCHG REMOVAL OF FOREIGN BODY - SIMPLE
|
Facility
|
OP
|
$5,612.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
H4500927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,555.88 |
| Rate for Payer: AlohaCare Medicaid |
$2,806.00
|
| Rate for Payer: AlohaCare Medicare |
$5,050.80
|
| Rate for Payer: Cash Price |
$3,647.80
|
| Rate for Payer: Cash Price |
$3,647.80
|
| Rate for Payer: Devoted Health Medicare |
$5,555.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,050.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,331.40
|
| Rate for Payer: Health Management Network Commercial |
$4,770.20
|
| Rate for Payer: Humana Medicare |
$5,050.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,050.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,050.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,443.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,050.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,050.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,050.80
|
| Rate for Payer: University Health Alliance Commercial |
$4,090.59
|
|
|
HCHG REMOVAL OF PILONIDAL LESION
|
Facility
|
IP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
H4500923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,173.55 |
| Max. Negotiated Rate |
$7,045.11 |
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,536.70
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
|
|
HCHG REMOVAL OF PILONIDAL LESION
|
Facility
|
OP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
H4500923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,190.37 |
| Rate for Payer: AlohaCare Medicaid |
$3,631.50
|
| Rate for Payer: AlohaCare Medicare |
$6,536.70
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Devoted Health Medicare |
$7,190.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6,536.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,899.85
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Humana Medicare |
$6,536.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,536.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,536.70
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,536.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,536.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,536.70
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HCHG REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
H4501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$616.50
|
| Rate for Payer: AlohaCare Medicare |
$1,109.70
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$1,220.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,109.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,171.35
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$1,109.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,109.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,109.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,109.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,109.70
|
| Rate for Payer: University Health Alliance Commercial |
$898.73
|
|
|
HCHG REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
H4501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG REMOVE EMBEDDED FB MOUTH VESTIB
|
Facility
|
IP
|
$3,986.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
H4500662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,388.10 |
| Max. Negotiated Rate |
$3,866.42 |
| Rate for Payer: Cash Price |
$2,590.90
|
| Rate for Payer: Health Management Network Commercial |
$3,388.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,587.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,866.42
|
|
|
HCHG REMOVE EMBEDDED FB MOUTH VESTIB
|
Facility
|
OP
|
$3,986.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
H4500662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,946.14 |
| Rate for Payer: AlohaCare Medicaid |
$1,993.00
|
| Rate for Payer: AlohaCare Medicare |
$3,587.40
|
| Rate for Payer: Cash Price |
$2,590.90
|
| Rate for Payer: Cash Price |
$2,590.90
|
| Rate for Payer: Devoted Health Medicare |
$3,946.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,587.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,786.70
|
| Rate for Payer: Health Management Network Commercial |
$3,388.10
|
| Rate for Payer: Humana Medicare |
$3,587.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,587.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,587.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,866.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,587.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,587.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,587.40
|
| Rate for Payer: University Health Alliance Commercial |
$2,905.40
|
|
|
HCHG REMOVE EYELID FOREIGN BODY
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
H4500987
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,718.64 |
| Rate for Payer: AlohaCare Medicaid |
$868.00
|
| Rate for Payer: AlohaCare Medicare |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Devoted Health Medicare |
$1,718.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,562.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,649.20
|
| Rate for Payer: Health Management Network Commercial |
$1,475.60
|
| Rate for Payer: Humana Medicare |
$1,562.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,562.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,562.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,683.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,562.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,562.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,562.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,265.37
|
|
|
HCHG REMOVE EYELID FOREIGN BODY
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
H4500987
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$1,683.92 |
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Health Management Network Commercial |
$1,475.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,562.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,683.92
|
|
|
HCHG REMOVE FB CONJUCTIVA EMBEDDED
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
H4500602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,098.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,060.00
|
| Rate for Payer: AlohaCare Medicare |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,378.00
|
| Rate for Payer: Cash Price |
$1,378.00
|
| Rate for Payer: Devoted Health Medicare |
$2,098.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,908.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,014.00
|
| Rate for Payer: Health Management Network Commercial |
$1,802.00
|
| Rate for Payer: Humana Medicare |
$1,908.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,908.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,908.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,056.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,908.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,908.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,908.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,545.27
|
|
|
HCHG REMOVE FB CONJUCTIVA EMBEDDED
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
H4500602
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,802.00 |
| Max. Negotiated Rate |
$2,056.40 |
| Rate for Payer: Cash Price |
$1,378.00
|
| Rate for Payer: Health Management Network Commercial |
$1,802.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,908.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,056.40
|
|
|
HCHG REMOVE FB CONJUCTIVA SUPERFIC
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
H4500604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$734.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$807.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$734.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$734.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$734.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$734.40
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
|
HCHG REMOVE FB CONJUCTIVA SUPERFIC
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
H4500604
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG REMOVE FB CORNEA WO SLIT LAMP
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
H4500608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,907.40 |
| Max. Negotiated Rate |
$2,176.68 |
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Health Management Network Commercial |
$1,907.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,019.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,176.68
|
|
|
HCHG REMOVE FB CORNEA WO SLIT LAMP
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
H4500608
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,221.56 |
| Rate for Payer: AlohaCare Medicaid |
$1,122.00
|
| Rate for Payer: AlohaCare Medicare |
$2,019.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Devoted Health Medicare |
$2,221.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,019.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,131.80
|
| Rate for Payer: Health Management Network Commercial |
$1,907.40
|
| Rate for Payer: Humana Medicare |
$2,019.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,019.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,019.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,176.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,019.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,019.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,019.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,635.65
|
|
|
HCHG REMOVE FB CORNEA W SLIT LAMP
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
H4500606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG REMOVE FB CORNEA W SLIT LAMP
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
H4500606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$734.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$807.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$734.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$734.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$734.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$734.40
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
