|
HCHG CLSD TX CALCANEAL FX WO MANIP
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
H4500850
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX CARPAL SCAPHOID FX
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
H4500186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX CARPAL SCAPHOID FX
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
H4500186
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX CARPOMETACARP DISLOC EAJNT
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
H4500188
|
|
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
|
|
|
HCHG CLSD TX CARPOMETACARP DISLOC EAJNT
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
H4500188
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$696.50
|
| Rate for Payer: AlohaCare Medicare |
$1,253.70
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Devoted Health Medicare |
$1,379.07
|
| 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 |
$1,253.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$1,253.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,253.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,253.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,351.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,253.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,253.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,253.70
|
| Rate for Payer: University Health Alliance Commercial |
$1,015.36
|
|
|
HCHG CLSD TX CLAVICLE FX WO MANIP
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
H4500192
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$696.50
|
| Rate for Payer: AlohaCare Medicare |
$1,253.70
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Cash Price |
$905.45
|
| Rate for Payer: Devoted Health Medicare |
$1,379.07
|
| 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 |
$1,253.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$1,253.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,253.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,253.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,351.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,253.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,253.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,253.70
|
| Rate for Payer: University Health Alliance Commercial |
$1,015.36
|
|
|
HCHG CLSD TX CLAVICLE FX WO MANIP
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
H4500192
|
|
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
|
|
|
HCHG CLSD TX DISLOC ELBOW
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
H4500830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX DISLOC ELBOW
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
H4500830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX DISTAL PHALAN FX W MANIP EA
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
H4500202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX DISTAL PHALAN FX W MANIP EA
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
H4500202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX DISTAL RADIAL FX
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
H4500206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$20,300.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$20,300.00
|
|
|
HCHG CLSD TX DISTAL RADIAL FX
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
H4500206
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX DIST BIFULAR FX
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
H4500194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX DIST BIFULAR FX
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
H4500194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX DIST FIB FX(LAT) W MANIP
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
H4500196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX DIST FIB FX(LAT) W MANIP
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
H4500196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX DIST RADIAL FX W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
H4500198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG CLSD TX DIST RADIAL FX W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
H4500198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,352.50
|
| Rate for Payer: AlohaCare Medicare |
$4,234.50
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$4,657.95
|
| 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 |
$4,234.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,234.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG CLSD TX FEM FX DISTAL END W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
H4500208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,657.95 |
| Rate for Payer: AlohaCare Medicaid |
$2,352.50
|
| Rate for Payer: AlohaCare Medicare |
$4,234.50
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$4,657.95
|
| 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 |
$4,234.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,234.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,234.50
|
| Rate for Payer: University Health Alliance Commercial |
$3,429.47
|
|
|
HCHG CLSD TX FEM FX DISTAL END W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
H4500208
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG CLSD TX FINGER DISLOC (IP)
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
H4500396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX FINGER DISLOC (IP)
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
H4500396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX FX GREAT TOE W MANIP
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
H4500222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX FX GREAT TOE W MANIP
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28495
|
| Hospital Charge Code |
H4500222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
