|
HCHG APPLIC SHORT LEG CAST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
H4500126
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$548.00
|
| Rate for Payer: AlohaCare Medicare |
$986.40
|
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Devoted Health Medicare |
$1,085.04
|
| 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 |
$986.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,041.20
|
| Rate for Payer: Health Management Network Commercial |
$931.60
|
| Rate for Payer: Humana Medicare |
$986.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$986.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,063.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$986.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$986.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$986.40
|
| Rate for Payer: University Health Alliance Commercial |
$798.87
|
|
|
HCHG APPLIC SPLINT FINGER STATIC
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
H4500684
|
|
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 APPLIC SPLINT FINGER STATIC
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
H4500684
|
|
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 APPLIC SPLINT LONG ARM
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
H4500686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$334.00
|
| Rate for Payer: AlohaCare Medicare |
$601.20
|
| Rate for Payer: Cash Price |
$434.20
|
| Rate for Payer: Cash Price |
$434.20
|
| Rate for Payer: Devoted Health Medicare |
$661.32
|
| 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 |
$601.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$634.60
|
| Rate for Payer: Health Management Network Commercial |
$567.80
|
| Rate for Payer: Humana Medicare |
$601.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.20
|
| Rate for Payer: MDX Hawaii PPO |
$647.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.20
|
| Rate for Payer: University Health Alliance Commercial |
$486.91
|
|
|
HCHG APPLIC SPLINT LONG ARM
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
HCPCS 29105
|
| Hospital Charge Code |
H4500686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$567.80 |
| Max. Negotiated Rate |
$647.96 |
| Rate for Payer: Cash Price |
$434.20
|
| Rate for Payer: Health Management Network Commercial |
$567.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.20
|
| Rate for Payer: MDX Hawaii PPO |
$647.96
|
|
|
HCHG APPLIC SPLINT LONG LEG
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
H4500688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$850.85 |
| Max. Negotiated Rate |
$970.97 |
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$900.90
|
| Rate for Payer: MDX Hawaii PPO |
$970.97
|
|
|
HCHG APPLIC SPLINT LONG LEG
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
H4500688
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$500.50
|
| Rate for Payer: AlohaCare Medicare |
$900.90
|
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Devoted Health Medicare |
$990.99
|
| 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 |
$900.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$950.95
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Humana Medicare |
$900.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$900.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$900.90
|
| Rate for Payer: MDX Hawaii PPO |
$970.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$900.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$900.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$900.90
|
| Rate for Payer: University Health Alliance Commercial |
$729.63
|
|
|
HCHG APPLIC SPLINT SHORT ARM
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
H4500690
|
|
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 APPLIC SPLINT SHORT ARM
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
H4500690
|
|
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 APPLIC SPLINT SHORT LEG
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
H4500692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$500.50
|
| Rate for Payer: AlohaCare Medicare |
$900.90
|
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Devoted Health Medicare |
$990.99
|
| 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 |
$900.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$950.95
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Humana Medicare |
$900.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$900.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$900.90
|
| Rate for Payer: MDX Hawaii PPO |
$970.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$900.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$900.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$900.90
|
| Rate for Payer: University Health Alliance Commercial |
$729.63
|
|
|
HCHG APPLIC SPLINT SHORT LEG
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
H4500692
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$850.85 |
| Max. Negotiated Rate |
$970.97 |
| Rate for Payer: Cash Price |
$650.65
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$900.90
|
| Rate for Payer: MDX Hawaii PPO |
$970.97
|
|
|
HCHG APPLY FOREARM SPLINT
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
H4500963
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$418.00
|
| Rate for Payer: AlohaCare Medicare |
$752.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Devoted Health Medicare |
$827.64
|
| 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 |
$752.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$794.20
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Humana Medicare |
$752.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$752.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$752.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$752.40
|
| Rate for Payer: University Health Alliance Commercial |
$609.36
|
|
|
HCHG APPLY FOREARM SPLINT
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
H4500963
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$752.40
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
HCHG APT TEST
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
H3010244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$67.90
|
|
|
HCHG APT TEST
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
H3010244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: AlohaCare Medicaid |
$35.00
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Devoted Health Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.00
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$67.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$15.41
|
|
|
HCHG ARGININE VASOPRESSIN
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
H3010246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$229.68 |
| Rate for Payer: AlohaCare Medicaid |
$116.00
|
| Rate for Payer: AlohaCare Medicare |
$208.80
|
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Devoted Health Medicare |
$229.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$208.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.94
|
| Rate for Payer: Health Management Network Commercial |
$197.20
|
| Rate for Payer: Humana Medicare |
$208.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$208.80
|
| Rate for Payer: MDX Hawaii PPO |
$225.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$208.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$208.80
|
| Rate for Payer: University Health Alliance Commercial |
$87.75
|
|
|
HCHG ARGININE VASOPRESSIN
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
H3010246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$225.04 |
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Health Management Network Commercial |
$197.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.80
|
| Rate for Payer: MDX Hawaii PPO |
$225.04
|
|
|
HCHG ARTERIAL CATH (ART LINE)
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
H4500128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$136.50
|
| Rate for Payer: AlohaCare Medicare |
$245.70
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Devoted Health Medicare |
$270.27
|
| 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 |
$245.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.35
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Humana Medicare |
$245.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.70
|
| Rate for Payer: University Health Alliance Commercial |
$198.99
|
|
|
HCHG ARTERIAL CATH (ART LINE)
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
H4500128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
HCHG ARTHROCENTESIS INTERM JNT
|
Facility
|
OP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
H4500130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$860.50
|
| Rate for Payer: AlohaCare Medicare |
$1,548.90
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Devoted Health Medicare |
$1,703.79
|
| 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 |
$1,548.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,634.95
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Humana Medicare |
$1,548.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,548.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,548.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,548.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,548.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,548.90
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG ARTHROCENTESIS INTERM JNT
|
Facility
|
IP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
H4500130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,462.85 |
| Max. Negotiated Rate |
$1,669.37 |
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,548.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
|
|
HCHG ARTHROCENTESIS LRG JT (SHLDR, HIP, KNEE) W/GUIDE
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
H3610632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,394.00 |
| Max. Negotiated Rate |
$1,590.80 |
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Health Management Network Commercial |
$1,394.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,590.80
|
|
|
HCHG ARTHROCENTESIS LRG JT (SHLDR, HIP, KNEE) W/GUIDE
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
H3610632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$820.00
|
| Rate for Payer: AlohaCare Medicare |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Cash Price |
$1,066.00
|
| Rate for Payer: Devoted Health Medicare |
$1,623.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,476.00
|
| Rate for Payer: Health Management Network Commercial |
$1,394.00
|
| Rate for Payer: Humana Medicare |
$1,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,476.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,590.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,476.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG ARTHROCENTESIS MAJOR JNT
|
Facility
|
OP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
H4500132
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$860.50
|
| Rate for Payer: AlohaCare Medicare |
$1,548.90
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Devoted Health Medicare |
$1,703.79
|
| 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 |
$1,548.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,634.95
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Humana Medicare |
$1,548.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,548.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,548.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,548.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,548.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,548.90
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG ARTHROCENTESIS MAJOR JNT
|
Facility
|
IP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
H4500132
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,462.85 |
| Max. Negotiated Rate |
$1,669.37 |
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,548.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
|
