|
20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
8022752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$338.50 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$338.50
|
| Rate for Payer: AlohaCare Medicare |
$338.50
|
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Devoted Health Medicare |
$372.35
|
| 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 |
$338.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$643.15
|
| Rate for Payer: Health Management Network Commercial |
$575.45
|
| Rate for Payer: Humana Medicare |
$338.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$338.50
|
| Rate for Payer: MDX Hawaii PPO |
$656.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$338.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
8022752
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$575.45 |
| Max. Negotiated Rate |
$656.69 |
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Health Management Network Commercial |
$575.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.30
|
| Rate for Payer: MDX Hawaii PPO |
$656.69
|
|
|
20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
8037398
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: AlohaCare Medicaid |
$37.23
|
| Rate for Payer: AlohaCare Medicare |
$36.40
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Devoted Health Medicare |
$40.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$169.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.40
|
| Rate for Payer: University Health Alliance Commercial |
$45.72
|
|
|
20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
8037398
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$37.23
|
| Rate for Payer: AlohaCare Medicare |
$36.40
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$40.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$45.72
|
|
|
20552-Inject Trigger Point 1-2 Muscles
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
8080224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$575.45 |
| Max. Negotiated Rate |
$656.69 |
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Health Management Network Commercial |
$575.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.30
|
| Rate for Payer: MDX Hawaii PPO |
$656.69
|
|
|
20552-Inject Trigger Point 1-2 Muscles
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
8080224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$338.50
|
| Rate for Payer: AlohaCare Medicare |
$338.50
|
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Cash Price |
$440.05
|
| Rate for Payer: Devoted Health Medicare |
$372.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$338.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$643.15
|
| Rate for Payer: Health Management Network Commercial |
$575.45
|
| Rate for Payer: Humana Medicare |
$338.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$609.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$345.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$338.50
|
| Rate for Payer: MDX Hawaii PPO |
$656.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$338.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$338.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$338.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES TechFee
|
Facility
|
OP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
8022753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$624.00
|
| Rate for Payer: AlohaCare Medicare |
$624.00
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Devoted Health Medicare |
$686.40
|
| 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 |
$624.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,185.60
|
| Rate for Payer: Health Management Network Commercial |
$1,060.80
|
| Rate for Payer: Humana Medicare |
$624.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,123.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$624.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,210.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$624.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$624.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$624.00
|
| Rate for Payer: University Health Alliance Commercial |
$909.67
|
|
|
20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES TechFee
|
Facility
|
IP
|
$1,248.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
8022753
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,210.56 |
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Management Network Commercial |
$1,060.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,123.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,210.56
|
|
|
20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s)
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
8037399
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: AlohaCare Medicaid |
$42.33
|
| Rate for Payer: AlohaCare Medicare |
$41.50
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$45.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$67.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: University Health Alliance Commercial |
$52.01
|
|
|
20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes)
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
8037400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$35.89
|
| Rate for Payer: AlohaCare Medicare |
$31.28
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$34.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$47.04
|
|
|
20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
8022754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,003.00 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
|
|
20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
8022754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$590.00
|
| Rate for Payer: AlohaCare Medicare |
$590.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Devoted Health Medicare |
$649.00
|
| 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 |
$590.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,121.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Humana Medicare |
$590.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$590.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$590.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$590.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$590.00
|
| Rate for Payer: University Health Alliance Commercial |
$860.10
|
|
|
20600 Drain Inject Joint Bursa Bilat Charges
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600 50
|
| Hospital Charge Code |
8221495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,003.00 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
|
|
20600 Drain Inject Joint Bursa Bilat Charges
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600 50
|
| Hospital Charge Code |
8221495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: AlohaCare Medicaid |
$590.00
|
| Rate for Payer: AlohaCare Medicare |
$590.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Devoted Health Medicare |
$649.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$590.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,121.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Humana Medicare |
$590.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$590.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$590.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$590.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$590.00
|
| Rate for Payer: University Health Alliance Commercial |
$660.80
|
|
|
20600 Drain Inject Joint Bursa LT Charges
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600 LT
|
| Hospital Charge Code |
8221496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,003.00 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
|
|
20600 Drain Inject Joint Bursa LT Charges
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600 LT
|
| Hospital Charge Code |
8221496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: AlohaCare Medicaid |
$590.00
|
| Rate for Payer: AlohaCare Medicare |
$590.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Devoted Health Medicare |
$649.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$590.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,121.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Humana Medicare |
$590.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$590.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$590.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$590.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$590.00
|
| Rate for Payer: University Health Alliance Commercial |
$660.80
|
|
|
20600 Drain Inject Joint Bursa RT Charges
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600 RT
|
| Hospital Charge Code |
8221497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: AlohaCare Medicaid |
$590.00
|
| Rate for Payer: AlohaCare Medicare |
$590.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Devoted Health Medicare |
$649.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$590.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,121.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Humana Medicare |
$590.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$601.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$590.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$590.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$590.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$590.00
|
| Rate for Payer: University Health Alliance Commercial |
$660.80
|
|
|
20600 Drain Inject Joint Bursa RT Charges
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 20600 RT
|
| Hospital Charge Code |
8221497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,003.00 |
| Max. Negotiated Rate |
$1,144.60 |
| Rate for Payer: Cash Price |
$767.00
|
| Rate for Payer: Health Management Network Commercial |
$1,003.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,062.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,144.60
|
|
|
20600-Small Joint Aspirate/Inject w/o US
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
8080227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$550.00
|
| Rate for Payer: AlohaCare Medicare |
$550.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Devoted Health Medicare |
$605.00
|
| 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 |
$550.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,045.00
|
| Rate for Payer: Health Management Network Commercial |
$935.00
|
| Rate for Payer: Humana Medicare |
$550.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$990.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$550.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,067.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$550.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$550.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$550.00
|
| Rate for Payer: University Health Alliance Commercial |
$801.79
|
|
|
20600-Small Joint Aspirate/Inject w/o US
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
8080227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$935.00 |
| Max. Negotiated Rate |
$1,067.00 |
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Health Management Network Commercial |
$935.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$990.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,067.00
|
|
|
20604 ARTHROCENTESIS, SMALL JOINT WITH ULTRASOUND [HHSC]
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
13001613
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$45.64
|
| Rate for Payer: AlohaCare Medicare |
$39.16
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$43.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$71.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$60.55
|
|
|
20604 Drain/Inj Small Joint Bursa w/US
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
8891049
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$45.64
|
| Rate for Payer: AlohaCare Medicare |
$39.16
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$43.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$71.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$60.55
|
|
|
20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8037401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$36.94
|
| Rate for Payer: AlohaCare Medicare |
$31.95
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Cash Price |
$277.55
|
| Rate for Payer: Devoted Health Medicare |
$35.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$48.93
|
|
|
20605 CT Aspiration Bursa Med Joint Charges
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8221485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$684.25 |
| Max. Negotiated Rate |
$780.85 |
| Rate for Payer: Cash Price |
$523.25
|
| Rate for Payer: Health Management Network Commercial |
$684.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$724.50
|
| Rate for Payer: MDX Hawaii PPO |
$780.85
|
|
|
20605 CT Aspiration Bursa Med Joint Charges
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8221485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$402.50
|
| Rate for Payer: AlohaCare Medicare |
$402.50
|
| Rate for Payer: Cash Price |
$523.25
|
| Rate for Payer: Cash Price |
$523.25
|
| Rate for Payer: Cash Price |
$523.25
|
| Rate for Payer: Devoted Health Medicare |
$442.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$764.75
|
| Rate for Payer: Health Management Network Commercial |
$684.25
|
| Rate for Payer: Humana Medicare |
$402.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$724.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$410.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.50
|
| Rate for Payer: MDX Hawaii PPO |
$780.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
