|
20605 Drain Inj Interm JT Bursa Bil Charges
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605 50
|
| Hospital Charge Code |
8221489
|
|
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 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
|
|
|
20605 Drain Inj Interm JT Bursa Bil Charges
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605 50
|
| Hospital Charge Code |
8221489
|
|
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 Drain Inj Interm JT Bursa LT Charges
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605 LT
|
| Hospital Charge Code |
8221490
|
|
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 Drain Inj Interm JT Bursa LT Charges
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605 LT
|
| Hospital Charge Code |
8221490
|
|
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 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
|
|
|
20605 Drain Inj Interm JT Bursa RT Charges
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605 RT
|
| Hospital Charge Code |
8221491
|
|
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 Drain Inj Interm JT Bursa RT Charges
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605 RT
|
| Hospital Charge Code |
8221491
|
|
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 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
|
|
|
20605-Intermediate Aspiration/Inj w/o US
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8080229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.50 |
| 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: Devoted Health Medicare |
$442.75
|
| 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 |
$402.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 Medicare |
$402.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20605-Intermediate Aspiration/Inj w/o US
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8080229
|
|
Hospital Revenue Code
|
450
|
| 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 US Aspiration Bursa Med Joint Charges
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8221513
|
|
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
|
|
|
20605 US Aspiration Bursa Med Joint Charges
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
8221513
|
|
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
|
|
|
20606 ARTHROCENTESIS, INTERMEDIATE JOINT WITH ULTRASOUND [HHSC]
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
13005132
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$51.78
|
| Rate for Payer: AlohaCare Medicare |
$44.17
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Devoted Health Medicare |
$48.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.61
|
| 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 |
$86.32
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.00
|
| 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 |
$51.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.17
|
| 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 |
$68.25
|
|
|
20606 ARTHROCENTESIS W US GUIDANCE
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
9338524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,140.70 |
| Max. Negotiated Rate |
$1,301.74 |
| Rate for Payer: Cash Price |
$872.30
|
| Rate for Payer: Health Management Network Commercial |
$1,140.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,207.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,301.74
|
|
|
20606 ARTHROCENTESIS W US GUIDANCE
|
Facility
|
OP
|
$1,342.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
9338524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$671.00
|
| Rate for Payer: AlohaCare Medicare |
$671.00
|
| Rate for Payer: Cash Price |
$872.30
|
| Rate for Payer: Cash Price |
$872.30
|
| Rate for Payer: Cash Price |
$872.30
|
| Rate for Payer: Devoted Health Medicare |
$738.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$901.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$671.00
|
| Rate for Payer: Health Management Network Commercial |
$1,140.70
|
| Rate for Payer: Humana Medicare |
$671.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,207.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$671.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,301.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$671.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$671.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$671.00
|
| Rate for Payer: University Health Alliance Commercial |
$751.52
|
|
|
20606 Drain/Inj Inter Joint Bursa w/US
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
8891050
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$834.70 |
| Rate for Payer: AlohaCare Medicaid |
$51.78
|
| Rate for Payer: AlohaCare Medicare |
$44.17
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Cash Price |
$638.30
|
| Rate for Payer: Devoted Health Medicare |
$48.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.61
|
| 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 |
$86.32
|
| Rate for Payer: Health Management Network Commercial |
$834.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.00
|
| 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 |
$51.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.17
|
| 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 |
$68.25
|
|
|
20610 Arthrocentesis aspiration and/or injection major joint or bursa without ultrasound guidance
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
8037402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$45.55
|
| Rate for Payer: AlohaCare Medicare |
$39.25
|
| 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 |
$43.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$70.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| 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 |
$181.39
|
| 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 |
$58.76
|
| Rate for Payer: Health Management Network Commercial |
$362.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.10
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
8022756
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$634.95 |
| Max. Negotiated Rate |
$724.59 |
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
|
|
20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
8022756
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.50 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$373.50
|
| Rate for Payer: AlohaCare Medicare |
$373.50
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Devoted Health Medicare |
$410.85
|
| 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 |
$373.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.65
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Humana Medicare |
$373.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.50
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20610 Drain Inj Major JT Bursa Bil Charges
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610 50
|
| Hospital Charge Code |
8221492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$373.50
|
| Rate for Payer: AlohaCare Medicare |
$373.50
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Devoted Health Medicare |
$410.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.65
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Humana Medicare |
$373.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$380.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.50
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20610 Drain Inj Major JT Bursa Bil Charges
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610 50
|
| Hospital Charge Code |
8221492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.95 |
| Max. Negotiated Rate |
$724.59 |
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
|
|
20610 Drain Inj Major JT Bursa LT Charges
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610 LT
|
| Hospital Charge Code |
8221493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.95 |
| Max. Negotiated Rate |
$724.59 |
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
|
|
20610 Drain Inj Major JT Bursa LT Charges
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610 LT
|
| Hospital Charge Code |
8221493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$373.50
|
| Rate for Payer: AlohaCare Medicare |
$373.50
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Devoted Health Medicare |
$410.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.65
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Humana Medicare |
$373.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$380.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.50
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20610 Drain Inj Major JT Bursa RT Charges
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610 RT
|
| Hospital Charge Code |
8221494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.95 |
| Max. Negotiated Rate |
$724.59 |
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
|
|
20610 Drain Inj Major JT Bursa RT Charges
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 20610 RT
|
| Hospital Charge Code |
8221494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$373.50
|
| Rate for Payer: AlohaCare Medicare |
$373.50
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Devoted Health Medicare |
$410.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$709.65
|
| Rate for Payer: Health Management Network Commercial |
$634.95
|
| Rate for Payer: Humana Medicare |
$373.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$672.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$380.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.50
|
| Rate for Payer: MDX Hawaii PPO |
$724.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
20610-Major Joint Aspirate/Inject w/o US
|
Facility
|
IP
|
$717.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
8080231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.45 |
| Max. Negotiated Rate |
$695.49 |
| Rate for Payer: Cash Price |
$466.05
|
| Rate for Payer: Health Management Network Commercial |
$609.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$645.30
|
| Rate for Payer: MDX Hawaii PPO |
$695.49
|
|
|
20610-Major Joint Aspirate/Inject w/o US
|
Facility
|
OP
|
$717.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
8080231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.50 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$358.50
|
| Rate for Payer: AlohaCare Medicare |
$358.50
|
| Rate for Payer: Cash Price |
$466.05
|
| Rate for Payer: Cash Price |
$466.05
|
| Rate for Payer: Devoted Health Medicare |
$394.35
|
| 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 |
$358.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$681.15
|
| Rate for Payer: Health Management Network Commercial |
$609.45
|
| Rate for Payer: Humana Medicare |
$358.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$645.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$358.50
|
| Rate for Payer: MDX Hawaii PPO |
$695.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$358.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$358.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$358.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
