|
HCHG REMOVE IMPL VA DEVICE/SUBQ RESV
|
Facility
|
IP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
H4500616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,731.90 |
| Max. Negotiated Rate |
$3,117.58 |
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Health Management Network Commercial |
$2,731.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,117.58
|
|
|
HCHG REMOVE NAIL & MATRIX PERM
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
H4500618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG REMOVE NAIL & MATRIX PERM
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
H4500618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.23 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| 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 |
$480.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,414.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$1,637.11
|
|
|
HCHG REMOVE OF IMPLANT SUPERFIC
|
Facility
|
IP
|
$6,663.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
H5100994
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,663.55 |
| Max. Negotiated Rate |
$6,463.11 |
| Rate for Payer: Cash Price |
$4,330.95
|
| Rate for Payer: Health Management Network Commercial |
$5,663.55
|
| Rate for Payer: MDX Hawaii PPO |
$6,463.11
|
|
|
HCHG REMOVE OF IMPLANT SUPERFIC
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
H4500622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,771.43 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,673.05
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,098.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG REMOVE OF IMPLANT SUPERFIC
|
Facility
|
OP
|
$6,663.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
H5100994
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$6,463.11 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$4,330.95
|
| Rate for Payer: Cash Price |
$4,330.95
|
| Rate for Payer: Cash Price |
$4,330.95
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,329.85
|
| Rate for Payer: Health Management Network Commercial |
$5,663.55
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,197.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,398.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,463.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG REMOVE OF IMPLANT SUPERFIC
|
Facility
|
IP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
H4500622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,181.15 |
| Max. Negotiated Rate |
$4,771.43 |
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
|
|
HCHG REMOVE TUNN VAD W SUBQ
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
H4500859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,733.60 |
| Rate for Payer: AlohaCare Medicaid |
$1,859.62
|
| Rate for Payer: AlohaCare Medicare |
$1,859.62
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Devoted Health Medicare |
$2,045.58
|
| 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 |
$1,859.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,636.00
|
| Rate for Payer: Health Management Network Commercial |
$4,148.00
|
| Rate for Payer: Humana Medicare |
$1,859.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,074.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,859.62
|
| Rate for Payer: MDX Hawaii PPO |
$4,733.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,045.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,859.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,859.62
|
| Rate for Payer: University Health Alliance Commercial |
$3,557.03
|
|
|
HCHG REMOVE TUNN VAD W SUBQ
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
H4500859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,148.00 |
| Max. Negotiated Rate |
$4,733.60 |
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Health Management Network Commercial |
$4,148.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,733.60
|
|
|
HCHG RENAL PROFILE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
H3011132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
|
|
HCHG RENAL PROFILE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
H3011132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: AlohaCare Medicaid |
$8.68
|
| Rate for Payer: AlohaCare Medicare |
$8.68
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Devoted Health Medicare |
$9.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.68
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Humana Medicare |
$8.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.68
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.68
|
| Rate for Payer: University Health Alliance Commercial |
$22.44
|
|
|
HCHG RENAL SCAN FLOW/FUNC
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
H3410314
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$1,910.90 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,280.50
|
| Rate for Payer: Cash Price |
$1,280.50
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$1,674.50
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,241.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,004.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$1,910.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$485.55
|
|
|
HCHG RENAL SCAN FLOW/FUNC
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
H3410314
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,674.50 |
| Max. Negotiated Rate |
$1,910.90 |
| Rate for Payer: Cash Price |
$1,280.50
|
| Rate for Payer: Health Management Network Commercial |
$1,674.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,910.90
|
|
|
HCHG RENAL SCAN FLOW/FUNC W PHARM
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
H3410316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$1,910.90 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,280.50
|
| Rate for Payer: Cash Price |
$1,280.50
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$1,674.50
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,241.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,004.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$1,910.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$424.67
|
|
|
HCHG RENAL SCAN FLOW/FUNC W PHARM
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
H3410316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,674.50 |
| Max. Negotiated Rate |
$1,910.90 |
| Rate for Payer: Cash Price |
$1,280.50
|
| Rate for Payer: Health Management Network Commercial |
$1,674.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,910.90
|
|
|
HCHG RENIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
|
|
HCHG RENIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: AlohaCare Medicaid |
$21.99
|
| Rate for Payer: AlohaCare Medicare |
$21.99
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Devoted Health Medicare |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.99
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Humana Medicare |
$21.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.99
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.99
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
|
|
HCHG RENIN ACTIVITY PLASMA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: AlohaCare Medicaid |
$21.99
|
| Rate for Payer: AlohaCare Medicare |
$21.99
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Devoted Health Medicare |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.99
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Humana Medicare |
$21.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.99
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.99
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
|
|
HCHG RENIN ACTIVITY PLASMA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
|
|
HCHG REPAIR BLOOD VESSEL,DIRECT,HAND,FINGER
|
Facility
|
OP
|
$8,375.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
H4500902
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,956.25
|
| Rate for Payer: Health Management Network Commercial |
$7,118.75
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,276.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: MDX Hawaii PPO |
$8,123.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,103.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,730.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
HCHG REPAIR BLOOD VESSEL,DIRECT,HAND,FINGER
|
Facility
|
IP
|
$8,375.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
H4500902
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,118.75 |
| Max. Negotiated Rate |
$8,123.75 |
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Health Management Network Commercial |
$7,118.75
|
| Rate for Payer: MDX Hawaii PPO |
$8,123.75
|
|
|
HCHG REPAIR BLOOD VESSEL DIR UP EXT
|
Facility
|
IP
|
$7,819.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
H4500858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,646.15 |
| Max. Negotiated Rate |
$7,584.43 |
| Rate for Payer: Cash Price |
$5,082.35
|
| Rate for Payer: Health Management Network Commercial |
$6,646.15
|
| Rate for Payer: MDX Hawaii PPO |
$7,584.43
|
|
|
HCHG REPAIR BLOOD VESSEL DIR UP EXT
|
Facility
|
OP
|
$7,819.00
|
|
|
Service Code
|
HCPCS 35206
|
| Hospital Charge Code |
H4500858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$9,416.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Cash Price |
$5,082.35
|
| Rate for Payer: Cash Price |
$5,082.35
|
| Rate for Payer: Cash Price |
$5,082.35
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,428.05
|
| Rate for Payer: Health Management Network Commercial |
$6,646.15
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,925.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: MDX Hawaii PPO |
$7,584.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,103.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,730.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$5,699.27
|
|
|
HCHG REPAIR EXT TENDON FINGER
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
H4500632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$10,679.55 |
| 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 |
$10,679.55
|
|
|
HCHG REPAIR EXT TENDON FINGER
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
H4500632
|
|
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
|
|
