|
HCHG CLSD TX HUMERAL EPICONDYLAR FX MEDIAL/LATERAL WO MANIP
|
Facility
|
IP
|
$1,365.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
H4500893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,160.25 |
| Max. Negotiated Rate |
$1,324.05 |
| Rate for Payer: Cash Price |
$887.25
|
| Rate for Payer: Health Management Network Commercial |
$1,160.25
|
| Rate for Payer: MDX Hawaii PPO |
$1,324.05
|
|
|
HCHG CLSD TX HUMERAL SHFT FX W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
H4500232
|
|
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: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG CLSD TX HUMERAL SHFT FX W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
H4500232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| 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 |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,964.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$3,429.47
|
|
|
HCHG CLSD TX KNEE DISLOC WO ANESTH
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
H4500236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,833.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| 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 |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX KNEE DISLOC WO ANESTH
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
H4500236
|
|
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: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX LUNATE DISLOC W MANIP
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
H4500238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,468.93 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$4,334.85
|
| Rate for Payer: Cash Price |
$4,334.85
|
| Rate for Payer: Cash Price |
$4,334.85
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,335.55
|
| Rate for Payer: Health Management Network Commercial |
$5,668.65
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,201.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$6,468.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$4,861.03
|
|
|
HCHG CLSD TX LUNATE DISLOC W MANIP
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS 25690
|
| Hospital Charge Code |
H4500238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,668.65 |
| Max. Negotiated Rate |
$6,468.93 |
| Rate for Payer: Cash Price |
$4,334.85
|
| Rate for Payer: Health Management Network Commercial |
$5,668.65
|
| Rate for Payer: MDX Hawaii PPO |
$6,468.93
|
|
|
HCHG CLSD TX MEDIAL MALLEO FX W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
H4500244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| 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 |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,964.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$3,429.47
|
|
|
HCHG CLSD TX MEDIAL MALLEO FX W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
H4500244
|
|
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: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG CLSD TX METACARP DISLOC WO ANESTH
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
H4500170
|
|
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: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX METACARP DISLOC WO ANESTH
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
H4500170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$2,833.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| 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 |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX METACARP FX EA BONE
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
H4500246
|
|
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: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX METACARP FX EA BONE
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
H4500246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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 |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX METACARP FX W MA EA BONE
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
H4500248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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 |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG CLSD TX METACARP FX W MA EA BONE
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
H4500248
|
|
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: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX METATARSAL FX W MANIP EA
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
H4500252
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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 |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX METATARSAL FX W MANIP EA
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28475
|
| Hospital Charge Code |
H4500252
|
|
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: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX MONTEG FX DISLOC ELBOW W MANIP
|
Facility
|
OP
|
$4,766.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
H4500254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,623.02 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,097.90
|
| Rate for Payer: Cash Price |
$3,097.90
|
| Rate for Payer: Cash Price |
$3,097.90
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,527.70
|
| Rate for Payer: Health Management Network Commercial |
$4,051.10
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,002.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$4,623.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CLSD TX MONTEG FX DISLOC ELBOW W MANIP
|
Facility
|
IP
|
$4,766.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
H4500254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,051.10 |
| Max. Negotiated Rate |
$4,623.02 |
| Rate for Payer: Cash Price |
$3,097.90
|
| Rate for Payer: Health Management Network Commercial |
$4,051.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,623.02
|
|
|
HCHG CLSD TX MTP JNT DISLOC WO ANESTH
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
H4500256
|
|
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: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLSD TX MTP JNT DISLOC WO ANESTH
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28630
|
| Hospital Charge Code |
H4500256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| 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 |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG CLSD TX NASAL BONE FX WO STABIL
|
Facility
|
IP
|
$4,554.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
H4500260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,870.90 |
| Max. Negotiated Rate |
$4,417.38 |
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,417.38
|
|
|
HCHG CLSD TX NASAL BONE FX WO STABIL
|
Facility
|
OP
|
$4,554.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
H4500260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,417.38 |
| Rate for Payer: AlohaCare Medicaid |
$1,832.96
|
| Rate for Payer: AlohaCare Medicare |
$1,832.96
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Cash Price |
$2,960.10
|
| Rate for Payer: Devoted Health Medicare |
$2,016.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,832.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,326.30
|
| Rate for Payer: Health Management Network Commercial |
$3,870.90
|
| Rate for Payer: Humana Medicare |
$1,832.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,869.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,832.96
|
| Rate for Payer: MDX Hawaii PPO |
$4,417.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,016.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,832.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,832.96
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CLSD TX NOSE/JAW FX
|
Facility
|
IP
|
$6,641.00
|
|
|
Service Code
|
HCPCS 21345
|
| Hospital Charge Code |
K4500009
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,644.85 |
| Max. Negotiated Rate |
$6,441.77 |
| Rate for Payer: Cash Price |
$4,316.65
|
| Rate for Payer: Health Management Network Commercial |
$5,644.85
|
| Rate for Payer: MDX Hawaii PPO |
$6,441.77
|
|
|
HCHG CLSD TX NOSE/JAW FX
|
Facility
|
OP
|
$6,641.00
|
|
|
Service Code
|
HCPCS 21345
|
| Hospital Charge Code |
K4500009
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$16,700.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,832.96
|
| Rate for Payer: AlohaCare Medicare |
$1,832.96
|
| Rate for Payer: Cash Price |
$4,316.65
|
| Rate for Payer: Cash Price |
$4,316.65
|
| Rate for Payer: Cash Price |
$4,316.65
|
| Rate for Payer: Devoted Health Medicare |
$2,016.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,832.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,308.95
|
| Rate for Payer: Health Management Network Commercial |
$5,644.85
|
| Rate for Payer: Humana Medicare |
$1,832.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,183.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,832.96
|
| Rate for Payer: MDX Hawaii PPO |
$6,441.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,016.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,832.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,832.96
|
| Rate for Payer: University Health Alliance Commercial |
$16,700.00
|
|
