|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$18,487.56
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$8,743.89 |
| Max. Negotiated Rate |
$18,487.56 |
| Rate for Payer: AlohaCare Medicare |
$8,743.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,487.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,743.89
|
| Rate for Payer: Humana Medicare |
$8,743.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,743.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,743.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,743.89
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$18,487.56
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$11,352.61 |
| Max. Negotiated Rate |
$18,487.56 |
| Rate for Payer: AlohaCare Medicare |
$11,352.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,487.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11,352.61
|
| Rate for Payer: Humana Medicare |
$11,352.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$11,352.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$11,352.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$11,352.61
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$18,487.56
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$6,762.97 |
| Max. Negotiated Rate |
$18,487.56 |
| Rate for Payer: AlohaCare Medicare |
$6,762.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,487.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6,762.97
|
| Rate for Payer: Humana Medicare |
$6,762.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,762.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,762.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,762.97
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$34,130.88
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$22,243.77 |
| Max. Negotiated Rate |
$34,130.88 |
| Rate for Payer: AlohaCare Medicare |
$22,243.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34,130.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22,243.77
|
| Rate for Payer: Humana Medicare |
$22,243.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$22,243.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$22,243.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$22,243.77
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$30,054.14
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$10,982.05 |
| Max. Negotiated Rate |
$30,054.14 |
| Rate for Payer: AlohaCare Medicare |
$10,982.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30,054.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10,982.05
|
| Rate for Payer: Humana Medicare |
$10,982.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$10,982.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$10,982.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$10,982.05
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$41,336.29
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$10,845.06 |
| Max. Negotiated Rate |
$41,336.29 |
| Rate for Payer: AlohaCare Medicare |
$10,845.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41,336.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10,845.06
|
| Rate for Payer: Humana Medicare |
$10,845.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$10,845.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$10,845.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$10,845.06
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$41,336.29
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$19,833.14 |
| Max. Negotiated Rate |
$41,336.29 |
| Rate for Payer: AlohaCare Medicare |
$19,833.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41,336.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19,833.14
|
| Rate for Payer: Humana Medicare |
$19,833.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$19,833.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$19,833.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$19,833.14
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$41,336.29
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$7,457.77 |
| Max. Negotiated Rate |
$41,336.29 |
| Rate for Payer: AlohaCare Medicare |
$7,457.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41,336.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,457.77
|
| Rate for Payer: Humana Medicare |
$7,457.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,457.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,457.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,457.77
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$32,258.42
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$15,468.20 |
| Max. Negotiated Rate |
$32,258.42 |
| Rate for Payer: AlohaCare Medicare |
$15,468.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32,258.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15,468.20
|
| Rate for Payer: Humana Medicare |
$15,468.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$15,468.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$15,468.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$15,468.20
|
|
|
Cognitive perform test
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 96125 GN
|
| Hospital Charge Code |
ST96125
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.40
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
|
|
Cognitive perform test
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 96125 GN
|
| Hospital Charge Code |
ST96125
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: AlohaCare Medicaid |
$253.00
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$480.70
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.06
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.65
|
| Rate for Payer: University Health Alliance Commercial |
$368.82
|
|
|
Cognitive Skill Dev Addl 15 Min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 97130 GN
|
| Hospital Charge Code |
ST97130
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
Cognitive Skill Dev Addl 15 Min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 97130 GO
|
| Hospital Charge Code |
OT97130
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
Cognitive Skill Dev Addl 15 Min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 97130 GN
|
| Hospital Charge Code |
ST97130
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.95
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$131.93
|
|
|
Cognitive Skill Dev Addl 15 Min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 97130 GO
|
| Hospital Charge Code |
OT97130
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.95
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.52
|
| Rate for Payer: University Health Alliance Commercial |
$131.93
|
|
|
Cognitive Skill Dev Addl 15 Min
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 97140 GN
|
| Hospital Charge Code |
ST97140
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.80
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
|
|
Cognitive Skill Dev Addl 15 Min
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 97140 GN
|
| Hospital Charge Code |
ST97140
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: AlohaCare Medicaid |
$96.00
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.92
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: University Health Alliance Commercial |
$139.95
|
|
|
Cognitive Skill Dev Initial 15 Min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 97129 GN
|
| Hospital Charge Code |
ST97129
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
Cognitive Skill Dev Initial 15 Min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 97129 GN
|
| Hospital Charge Code |
ST97129
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.95
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.57
|
| Rate for Payer: University Health Alliance Commercial |
$131.93
|
|
|
Cognitive Skill Dev Initial 15 Min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 97129 GO
|
| Hospital Charge Code |
OT97129
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.95
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.57
|
| Rate for Payer: University Health Alliance Commercial |
$131.93
|
|
|
Cognitive Skill Dev Initial 15 Min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 97129 GO
|
| Hospital Charge Code |
OT97129
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$115,594.65
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$89,228.66 |
| Max. Negotiated Rate |
$115,594.65 |
| Rate for Payer: AlohaCare Medicare |
$89,228.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$115,594.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89,228.66
|
| Rate for Payer: Humana Medicare |
$89,228.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$89,228.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$89,228.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$89,228.66
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$115,594.65
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$57,272.66 |
| Max. Negotiated Rate |
$115,594.65 |
| Rate for Payer: AlohaCare Medicare |
$57,272.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$115,594.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57,272.66
|
| Rate for Payer: Humana Medicare |
$57,272.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$57,272.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$57,272.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$57,272.66
|
|
|
COMPLEX AORTIC ARCH PROCEDURES
|
Facility
|
IP
|
$193,360.92
|
|
|
Service Code
|
MSDRG 209
|
| Min. Negotiated Rate |
$111,986.65 |
| Max. Negotiated Rate |
$193,360.92 |
| Rate for Payer: AlohaCare Medicare |
$111,986.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$193,360.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111,986.65
|
| Rate for Payer: Humana Medicare |
$111,986.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$111,986.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$111,986.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$111,986.65
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$23,796.81
|
|
|
Service Code
|
MSDRG 381
|
| Min. Negotiated Rate |
$11,114.11 |
| Max. Negotiated Rate |
$23,796.81 |
| Rate for Payer: AlohaCare Medicare |
$11,114.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23,796.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11,114.11
|
| Rate for Payer: Humana Medicare |
$11,114.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$11,114.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$11,114.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$11,114.11
|
|
