|
HB OBSERVATION CARVE-OUT - CARDIOLOGY
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037804
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
|
|
HC 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Facility
|
IP
|
$2,517.00
|
|
|
Service Code
|
HCPCS 99468
|
| Hospital Charge Code |
1739946801
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$2,441.49 |
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Cash Price |
$1,510.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,139.45
|
| Rate for Payer: MDX Hawaii PPO |
$2,441.49
|
| Rate for Payer: University Health Alliance Commercial |
$1,875.00
|
|
|
HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$974.85 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$102.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$954.75
|
| Rate for Payer: Health Management Network Commercial |
$854.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$633.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$512.55
|
| Rate for Payer: MDX Hawaii PPO |
$974.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.78
|
| Rate for Payer: University Health Alliance Commercial |
$272.82
|
|
|
HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$854.25 |
| Max. Negotiated Rate |
$974.85 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Health Management Network Commercial |
$854.25
|
| Rate for Payer: MDX Hawaii PPO |
$974.85
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
3507637601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$553.87 |
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$98.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.45
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$359.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.21
|
| Rate for Payer: MDX Hawaii PPO |
$553.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.13
|
| Rate for Payer: University Health Alliance Commercial |
$214.08
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
3507637601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.35 |
| Max. Negotiated Rate |
$553.87 |
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: MDX Hawaii PPO |
$553.87
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
3507637601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$692.58 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$98.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$678.30
|
| Rate for Payer: Health Management Network Commercial |
$606.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$449.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$364.14
|
| Rate for Payer: MDX Hawaii PPO |
$692.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.13
|
| Rate for Payer: University Health Alliance Commercial |
$214.08
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
3507637601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$606.90 |
| Max. Negotiated Rate |
$692.58 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Health Management Network Commercial |
$606.90
|
| Rate for Payer: MDX Hawaii PPO |
$692.58
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
3614908301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.46
|
| Rate for Payer: AlohaCare Medicare |
$1,071.46
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Devoted Health Medicare |
$1,178.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,071.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: Humana Medicare |
$1,071.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,350.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.46
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,178.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.46
|
| Rate for Payer: University Health Alliance Commercial |
$2,719.53
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
3614908301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,171.35 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
7614908201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,171.35 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
|
|
HC ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
7614908201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$3,619.07 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.46
|
| Rate for Payer: AlohaCare Medicare |
$1,071.46
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Cash Price |
$2,238.60
|
| Rate for Payer: Devoted Health Medicare |
$1,178.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,071.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,544.45
|
| Rate for Payer: Health Management Network Commercial |
$3,171.35
|
| Rate for Payer: Humana Medicare |
$1,071.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,350.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,902.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.46
|
| Rate for Payer: MDX Hawaii PPO |
$3,619.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,178.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.46
|
| Rate for Payer: University Health Alliance Commercial |
$2,719.53
|
|
|
HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION
|
Facility
|
OP
|
$41,433.00
|
|
|
Service Code
|
HCPCS 47383
|
| Hospital Charge Code |
3614738301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$40,190.01 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Cash Price |
$24,859.80
|
| Rate for Payer: Cash Price |
$24,859.80
|
| Rate for Payer: Cash Price |
$24,859.80
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,696.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Health Management Network Commercial |
$35,218.05
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$26,102.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: MDX Hawaii PPO |
$40,190.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
| Rate for Payer: University Health Alliance Commercial |
$30,200.51
|
|
|
HC ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION
|
Facility
|
IP
|
$41,433.00
|
|
|
Service Code
|
HCPCS 47383
|
| Hospital Charge Code |
3614738301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35,218.05 |
| Max. Negotiated Rate |
$40,190.01 |
| Rate for Payer: Cash Price |
$24,859.80
|
| Rate for Payer: Health Management Network Commercial |
$35,218.05
|
| Rate for Payer: MDX Hawaii PPO |
$40,190.01
|
|
|
HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE
|
Facility
|
OP
|
$51,205.00
|
|
|
Service Code
|
HCPCS 20982
|
| Hospital Charge Code |
3612098201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$49,668.85 |
| Rate for Payer: AlohaCare Medicaid |
$20,713.48
|
| Rate for Payer: AlohaCare Medicare |
$20,713.48
|
| Rate for Payer: Cash Price |
$30,723.00
|
| Rate for Payer: Cash Price |
$30,723.00
|
| Rate for Payer: Cash Price |
$30,723.00
|
| Rate for Payer: Devoted Health Medicare |
$22,784.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20,713.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Health Management Network Commercial |
$43,524.25
|
| Rate for Payer: Humana Medicare |
$20,713.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$32,259.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$20,713.48
|
| Rate for Payer: MDX Hawaii PPO |
$49,668.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22,784.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$20,713.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$20,713.48
|
| Rate for Payer: University Health Alliance Commercial |
$37,323.32
|
|
|
HC ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE
|
Facility
|
IP
|
$51,205.00
|
|
|
Service Code
|
HCPCS 20982
|
| Hospital Charge Code |
3612098201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43,524.25 |
| Max. Negotiated Rate |
$49,668.85 |
| Rate for Payer: Cash Price |
$30,723.00
|
| Rate for Payer: Health Management Network Commercial |
$43,524.25
|
| Rate for Payer: MDX Hawaii PPO |
$49,668.85
|
|
|
HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY
|
Facility
|
OP
|
$51,791.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
3505059301
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$50,237.27 |
| Rate for Payer: AlohaCare Medicaid |
$12,557.50
|
| Rate for Payer: AlohaCare Medicare |
$12,557.50
|
| Rate for Payer: Cash Price |
$31,074.60
|
| Rate for Payer: Cash Price |
$31,074.60
|
| Rate for Payer: Cash Price |
$31,074.60
|
| Rate for Payer: Devoted Health Medicare |
$13,813.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,149.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,778.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,557.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,294.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49,201.45
|
| Rate for Payer: Health Management Network Commercial |
$44,022.35
|
| Rate for Payer: Humana Medicare |
$12,557.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$32,628.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26,413.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,557.50
|
| Rate for Payer: MDX Hawaii PPO |
$50,237.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,813.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,557.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,557.50
|
| Rate for Payer: University Health Alliance Commercial |
$13,923.44
|
|
|
HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY
|
Facility
|
IP
|
$51,791.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
3505059301
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$44,022.35 |
| Max. Negotiated Rate |
$50,237.27 |
| Rate for Payer: Cash Price |
$31,074.60
|
| Rate for Payer: Health Management Network Commercial |
$44,022.35
|
| Rate for Payer: MDX Hawaii PPO |
$50,237.27
|
|
|
HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD
|
Facility
|
OP
|
$28,429.00
|
|
|
Service Code
|
HCPCS 20983
|
| Hospital Charge Code |
3612098301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$27,576.13 |
| Rate for Payer: AlohaCare Medicaid |
$8,572.09
|
| Rate for Payer: AlohaCare Medicare |
$8,572.09
|
| Rate for Payer: Cash Price |
$17,057.40
|
| Rate for Payer: Cash Price |
$17,057.40
|
| Rate for Payer: Cash Price |
$17,057.40
|
| Rate for Payer: Devoted Health Medicare |
$9,429.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,715.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8,572.09
|
| Rate for Payer: Health Management Network Commercial |
$24,164.65
|
| Rate for Payer: Humana Medicare |
$8,572.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$17,910.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,572.09
|
| Rate for Payer: MDX Hawaii PPO |
$27,576.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9,429.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,572.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,572.09
|
| Rate for Payer: University Health Alliance Commercial |
$20,721.90
|
|
|
HC ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD
|
Facility
|
IP
|
$28,429.00
|
|
|
Service Code
|
HCPCS 20983
|
| Hospital Charge Code |
3612098301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,164.65 |
| Max. Negotiated Rate |
$27,576.13 |
| Rate for Payer: Cash Price |
$17,057.40
|
| Rate for Payer: Health Management Network Commercial |
$24,164.65
|
| Rate for Payer: MDX Hawaii PPO |
$27,576.13
|
|
|
HC ABLAT,OPEN,1+ LIVER TUMOR(S),PERCUT RF
|
Facility
|
OP
|
$23,219.00
|
|
|
Service Code
|
HCPCS 47382
|
| Hospital Charge Code |
3614738201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$22,522.43 |
| Rate for Payer: AlohaCare Medicaid |
$7,141.85
|
| Rate for Payer: AlohaCare Medicare |
$7,141.85
|
| Rate for Payer: Cash Price |
$13,931.40
|
| Rate for Payer: Cash Price |
$13,931.40
|
| Rate for Payer: Cash Price |
$13,931.40
|
| Rate for Payer: Devoted Health Medicare |
$7,856.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7,141.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$19,736.15
|
| Rate for Payer: Humana Medicare |
$7,141.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,627.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,141.85
|
| Rate for Payer: MDX Hawaii PPO |
$22,522.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,856.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,141.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,141.85
|
| Rate for Payer: University Health Alliance Commercial |
$16,924.33
|
|
|
HC ABLAT,OPEN,1+ LIVER TUMOR(S),PERCUT RF
|
Facility
|
IP
|
$23,219.00
|
|
|
Service Code
|
HCPCS 47382
|
| Hospital Charge Code |
3614738201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19,736.15 |
| Max. Negotiated Rate |
$22,522.43 |
| Rate for Payer: Cash Price |
$13,931.40
|
| Rate for Payer: Health Management Network Commercial |
$19,736.15
|
| Rate for Payer: MDX Hawaii PPO |
$22,522.43
|
|
|
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF
|
Facility
|
OP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
3616066001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,438.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,977.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,602.27
|
|
|
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF
|
Facility
|
IP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
3616066001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,366.90 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
|
|
HC ABLTJ PERC PLEX/TRNCL NRV
|
Facility
|
OP
|
$25,486.00
|
|
|
Service Code
|
HCPCS 0442T
|
| Hospital Charge Code |
3610442T01
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$24,721.42 |
| Rate for Payer: AlohaCare Medicaid |
$10,367.30
|
| Rate for Payer: AlohaCare Medicare |
$10,367.30
|
| Rate for Payer: Cash Price |
$15,291.60
|
| Rate for Payer: Cash Price |
$15,291.60
|
| Rate for Payer: Cash Price |
$15,291.60
|
| Rate for Payer: Devoted Health Medicare |
$11,404.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,959.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10,367.30
|
| Rate for Payer: Health Management Network Commercial |
$21,663.10
|
| Rate for Payer: Humana Medicare |
$10,367.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16,056.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$10,367.30
|
| Rate for Payer: MDX Hawaii PPO |
$24,721.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11,404.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$10,367.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$10,367.30
|
| Rate for Payer: University Health Alliance Commercial |
$18,576.75
|
|
