|
30560 Lysis intranasal synechia
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 30560
|
| Hospital Charge Code |
8038552
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$704.65 |
| Rate for Payer: AlohaCare Medicaid |
$164.76
|
| Rate for Payer: AlohaCare Medicare |
$149.34
|
| Rate for Payer: Cash Price |
$538.85
|
| Rate for Payer: Cash Price |
$538.85
|
| Rate for Payer: Cash Price |
$538.85
|
| Rate for Payer: Devoted Health Medicare |
$164.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$235.09
|
| 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 |
$37.96
|
| Rate for Payer: Health Management Network Commercial |
$704.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.21
|
| 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 |
$164.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.34
|
| 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 |
$201.45
|
|
|
30580 Repair fistula; oromaxillary
|
Professional
|
Both
|
$8,239.00
|
|
|
Service Code
|
HCPCS 30580
|
| Hospital Charge Code |
8038553
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$7,003.15 |
| Rate for Payer: AlohaCare Medicaid |
$480.93
|
| Rate for Payer: AlohaCare Medicare |
$430.64
|
| Rate for Payer: Cash Price |
$5,355.35
|
| Rate for Payer: Cash Price |
$5,355.35
|
| Rate for Payer: Cash Price |
$5,355.35
|
| Rate for Payer: Devoted Health Medicare |
$473.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$742.55
|
| 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 |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$7,003.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$516.77
|
| 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 |
$480.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$430.64
|
| 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 |
$628.69
|
|
|
30630 Repair nasal septal perforations
|
Professional
|
Both
|
$4,614.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
8038554
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,921.90 |
| Rate for Payer: AlohaCare Medicaid |
$716.63
|
| Rate for Payer: AlohaCare Medicare |
$638.70
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Devoted Health Medicare |
$702.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$404.30
|
| Rate for Payer: Health Management Network Commercial |
$3,921.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$766.44
|
| 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 |
$716.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$638.70
|
| 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
|
|
|
30801 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method; superficial
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
8038555
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$1,835.15 |
| Rate for Payer: AlohaCare Medicaid |
$166.96
|
| Rate for Payer: AlohaCare Medicare |
$151.44
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Devoted Health Medicare |
$166.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230.95
|
| 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 |
$73.58
|
| Rate for Payer: Health Management Network Commercial |
$1,835.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.73
|
| 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 |
$166.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.44
|
| 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 |
$202.03
|
|
|
30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method; intramural
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
8038556
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$1,835.15 |
| Rate for Payer: AlohaCare Medicaid |
$217.89
|
| Rate for Payer: AlohaCare Medicare |
$193.80
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Cash Price |
$1,403.35
|
| Rate for Payer: Devoted Health Medicare |
$213.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$322.04
|
| 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 |
$97.24
|
| Rate for Payer: Health Management Network Commercial |
$1,835.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$232.56
|
| 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 |
$217.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.80
|
| 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 |
$265.35
|
|
|
30901-Anterior Simple
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8080160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$290.00
|
| Rate for Payer: AlohaCare Medicare |
$290.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Devoted Health Medicare |
$319.00
|
| 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 |
$290.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$551.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Humana Medicare |
$290.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$290.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$290.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$290.00
|
| Rate for Payer: University Health Alliance Commercial |
$422.76
|
|
|
30901-Anterior Simple
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8080160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.00 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Cash Price |
$377.00
|
| Rate for Payer: Health Management Network Commercial |
$493.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.00
|
| Rate for Payer: MDX Hawaii PPO |
$562.60
|
|
|
30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8051016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$314.50
|
| Rate for Payer: AlohaCare Medicare |
$314.50
|
| Rate for Payer: Cash Price |
$408.85
|
| Rate for Payer: Cash Price |
$408.85
|
| Rate for Payer: Devoted Health Medicare |
$345.95
|
| 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 |
$314.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$597.55
|
| Rate for Payer: Health Management Network Commercial |
$534.65
|
| Rate for Payer: Humana Medicare |
$314.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$566.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$314.50
|
| Rate for Payer: MDX Hawaii PPO |
$610.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$314.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$314.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$314.50
|
| Rate for Payer: University Health Alliance Commercial |
$458.48
|
|
|
30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8051016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$534.65 |
| Max. Negotiated Rate |
$610.13 |
| Rate for Payer: Cash Price |
$408.85
|
| Rate for Payer: Health Management Network Commercial |
$534.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$566.10
|
| Rate for Payer: MDX Hawaii PPO |
$610.13
|
|
|
30901 Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
8038557
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$55.46
|
| Rate for Payer: AlohaCare Medicare |
$48.15
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Devoted Health Medicare |
$52.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$86.88
|
| 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 |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$238.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.78
|
| 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 |
$55.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.15
|
| 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 |
$68.69
|
|
|
30903-Anterior Complex
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8080161
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$332.50
|
| Rate for Payer: AlohaCare Medicare |
$332.50
|
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Devoted Health Medicare |
$365.75
|
| 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 |
$332.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$631.75
|
| Rate for Payer: Health Management Network Commercial |
$565.25
|
| Rate for Payer: Humana Medicare |
$332.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$598.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.50
|
| Rate for Payer: MDX Hawaii PPO |
$645.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.50
|
| Rate for Payer: University Health Alliance Commercial |
$484.72
|
|
|
30903-Anterior Complex
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8080161
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$565.25 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Health Management Network Commercial |
$565.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$598.50
|
| Rate for Payer: MDX Hawaii PPO |
$645.05
|
|
|
30903 Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
8038558
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$67.29 |
| Max. Negotiated Rate |
$502.35 |
| Rate for Payer: AlohaCare Medicaid |
$75.24
|
| Rate for Payer: AlohaCare Medicare |
$67.29
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Devoted Health Medicare |
$74.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$117.98
|
| 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 |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$502.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.75
|
| 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 |
$75.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.29
|
| 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 |
$93.56
|
|
|
30905 CONTROL NASAL HEMOR,POSTERIOR- ER SERV P
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8051018
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$621.35 |
| Rate for Payer: AlohaCare Medicaid |
$104.24
|
| Rate for Payer: AlohaCare Medicare |
$96.74
|
| Rate for Payer: Cash Price |
$475.15
|
| Rate for Payer: Cash Price |
$475.15
|
| Rate for Payer: Cash Price |
$475.15
|
| Rate for Payer: Devoted Health Medicare |
$106.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$162.66
|
| 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 |
$126.62
|
| Rate for Payer: Health Management Network Commercial |
$621.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.09
|
| 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 |
$104.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.74
|
| 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 |
$137.72
|
|
|
30905-Posterior Initial
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8080162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$586.50 |
| Max. Negotiated Rate |
$669.30 |
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Health Management Network Commercial |
$586.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$621.00
|
| Rate for Payer: MDX Hawaii PPO |
$669.30
|
|
|
30905-Posterior Initial
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
8080162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$345.00
|
| Rate for Payer: AlohaCare Medicare |
$345.00
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Devoted Health Medicare |
$379.50
|
| 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 |
$345.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$655.50
|
| Rate for Payer: Health Management Network Commercial |
$586.50
|
| Rate for Payer: Humana Medicare |
$345.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$621.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$345.00
|
| Rate for Payer: MDX Hawaii PPO |
$669.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$345.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$345.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$345.00
|
| Rate for Payer: University Health Alliance Commercial |
$502.94
|
|
|
30906 Control nasal hemorrhage posterior subsequent
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
8038560
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$701.25 |
| Rate for Payer: AlohaCare Medicaid |
$131.48
|
| Rate for Payer: AlohaCare Medicare |
$116.63
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Cash Price |
$536.25
|
| Rate for Payer: Devoted Health Medicare |
$128.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$210.95
|
| 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 |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$701.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.96
|
| 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 |
$131.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.63
|
| 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 |
$178.60
|
|
|
30906-Posterior Subsequent
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
8080163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$658.00
|
| Rate for Payer: AlohaCare Medicare |
$658.00
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Devoted Health Medicare |
$723.80
|
| 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 |
$658.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,250.20
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Humana Medicare |
$658.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$658.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$658.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$658.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$658.00
|
| Rate for Payer: University Health Alliance Commercial |
$959.23
|
|
|
30906-Posterior Subsequent
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
8080163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,118.60 |
| Max. Negotiated Rate |
$1,276.52 |
| Rate for Payer: Cash Price |
$855.40
|
| Rate for Payer: Health Management Network Commercial |
$1,118.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,184.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,276.52
|
|
|
30915 Ligation arteries; ethmoidal
|
Professional
|
Both
|
$4,394.00
|
|
|
Service Code
|
HCPCS 30915
|
| Hospital Charge Code |
8038562
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$3,734.90 |
| Rate for Payer: AlohaCare Medicaid |
$639.96
|
| Rate for Payer: AlohaCare Medicare |
$561.73
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Cash Price |
$2,856.10
|
| Rate for Payer: Devoted Health Medicare |
$617.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$371.28
|
| Rate for Payer: Health Management Network Commercial |
$3,734.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$674.08
|
| 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 |
$639.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$561.73
|
| 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
|
|
|
30930 Fracture nasal inferior turbinate(s), therapeutic
|
Professional
|
Both
|
$4,614.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
8038563
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$3,921.90 |
| Rate for Payer: AlohaCare Medicaid |
$127.09
|
| Rate for Payer: AlohaCare Medicare |
$114.59
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Cash Price |
$2,999.10
|
| Rate for Payer: Devoted Health Medicare |
$126.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$70.98
|
| Rate for Payer: Health Management Network Commercial |
$3,921.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.51
|
| 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 |
$127.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.59
|
| 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
|
|
|
3-0 POLYSORB CV-25
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
8274567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Devoted Health Medicare |
$8.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.00
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.00
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
|
|
3-0 POLYSORB CV-25
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
8274567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
3.0 X 14MM VAL KREULOCK SCREW, TI
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12944328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,052.45 |
| Rate for Payer: AlohaCare Medicaid |
$542.50
|
| Rate for Payer: AlohaCare Medicare |
$542.50
|
| Rate for Payer: Cash Price |
$705.25
|
| Rate for Payer: Devoted Health Medicare |
$596.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$542.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$759.50
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Humana Medicare |
$542.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$553.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$542.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,052.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$542.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$542.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$542.50
|
| Rate for Payer: University Health Alliance Commercial |
$607.60
|
|
|
3.0 X 14MM VAL KREULOCK SCREW, TI
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12944328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$1,052.45 |
| Rate for Payer: Cash Price |
$705.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$759.50
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,052.45
|
| Rate for Payer: University Health Alliance Commercial |
$607.60
|
|
