|
HC JOINT SURVEY, SINGLE VIEW - XR JOINT ANTEROPOSTERIOR 2+ JOINTS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 77077
|
| Hospital Charge Code |
3207707701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$97.64
|
|
|
HC KEPPRA/LEVETRACETAM (WKEPPA)
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$13.25
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.25
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HC KEPPRA/LEVETRACETAM (WKEPPA)
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
3018017701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
3018201002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$8.17
|
| Rate for Payer: AlohaCare Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$8.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$8.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.17
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.17
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
3018201002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
HC K FLOW/FUNCT IMAGE MULTIPLE - NM KIDNEY FLOW/FUNC W/WO PHARMACOL INT
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$655.88
|
|
|
HC K FLOW/FUNCT IMAGE MULTIPLE - NM KIDNEY FLOW/FUNC W/WO PHARMACOL INT
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78709
|
| Hospital Charge Code |
3417870901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
3417870801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$424.67
|
|
|
HC K FLOW/FUNCT IMAGE W/DRUG
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78708
|
| Hospital Charge Code |
3417870801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC K FLOW/FUNCT IMAGE W/O DRUG - NM KIDNEY FLOW/FUNCT WO PHARMACOL INT
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
3417870701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$147.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$147.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$485.55
|
|
|
HC K FLOW/FUNCT IMAGE W/O DRUG - NM KIDNEY FLOW/FUNCT WO PHARMACOL INT
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
3417870701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC KIDNEY IMAGING MORPHOL - NM KIDNEY CORTEX
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78700
|
| Hospital Charge Code |
3417870001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$100.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$109.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$341.86
|
|
|
HC KIDNEY IMAGING MORPHOL - NM KIDNEY CORTEX
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78700
|
| Hospital Charge Code |
3417870001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC KIDNEY IMAGING WITH FLOW - NM KIDNEY WITH FLOW
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78701
|
| Hospital Charge Code |
3417870101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$116.98 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$116.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$127.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$405.87
|
|
|
HC KIDNEY IMAGING WITH FLOW - NM KIDNEY WITH FLOW
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78701
|
| Hospital Charge Code |
3417870101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC KIT D816V MUTATION ANALY
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
HCPCS 81273
|
| Hospital Charge Code |
3108127301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$890.80 |
| Max. Negotiated Rate |
$1,016.56 |
| Rate for Payer: Cash Price |
$628.80
|
| Rate for Payer: Health Management Network Commercial |
$890.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,016.56
|
|
|
HC KIT D816V MUTATION ANALY
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
HCPCS 81273
|
| Hospital Charge Code |
3108127301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$1,016.56 |
| Rate for Payer: AlohaCare Medicaid |
$124.87
|
| Rate for Payer: AlohaCare Medicare |
$124.87
|
| Rate for Payer: Cash Price |
$628.80
|
| Rate for Payer: Cash Price |
$628.80
|
| Rate for Payer: Devoted Health Medicare |
$137.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$92.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$156.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.87
|
| Rate for Payer: Health Management Network Commercial |
$890.80
|
| Rate for Payer: Humana Medicare |
$124.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$660.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$534.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.87
|
| Rate for Payer: MDX Hawaii PPO |
$1,016.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$74.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.87
|
| Rate for Payer: University Health Alliance Commercial |
$763.89
|
|
|
HC LABOR CARE LEVEL 1 PER HR
|
Facility
|
OP
|
$322.00
|
|
| Hospital Charge Code |
7200000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$164.22 |
| Max. Negotiated Rate |
$312.34 |
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$305.90
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.22
|
| Rate for Payer: MDX Hawaii PPO |
$312.34
|
| Rate for Payer: University Health Alliance Commercial |
$234.71
|
|
|
HC LABOR CARE LEVEL 1 PER HR
|
Facility
|
IP
|
$322.00
|
|
| Hospital Charge Code |
7200000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$273.70 |
| Max. Negotiated Rate |
$312.34 |
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: MDX Hawaii PPO |
$312.34
|
|
|
HC LABOR CARE LEVEL 2 PER HR
|
Facility
|
OP
|
$463.00
|
|
| Hospital Charge Code |
7200000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$236.13 |
| Max. Negotiated Rate |
$449.11 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$439.85
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$291.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.13
|
| Rate for Payer: MDX Hawaii PPO |
$449.11
|
| Rate for Payer: University Health Alliance Commercial |
$337.48
|
|
|
HC LABOR CARE LEVEL 2 PER HR
|
Facility
|
IP
|
$463.00
|
|
| Hospital Charge Code |
7200000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$393.55 |
| Max. Negotiated Rate |
$449.11 |
| Rate for Payer: Cash Price |
$277.80
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: MDX Hawaii PPO |
$449.11
|
|
|
HC LABOR EPIDURAL PLACEMENT
|
Facility
|
OP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
3616232601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: AlohaCare Medicaid |
$1,044.87
|
| Rate for Payer: AlohaCare Medicare |
$1,044.87
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Devoted Health Medicare |
$1,149.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,306.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,044.87
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: Humana Medicare |
$1,044.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,232.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,044.87
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,149.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,044.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,044.87
|
| Rate for Payer: University Health Alliance Commercial |
$2,582.49
|
|
|
HC LABOR EPIDURAL PLACEMENT
|
Facility
|
IP
|
$3,543.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
3616232601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,011.55 |
| Max. Negotiated Rate |
$3,436.71 |
| Rate for Payer: Cash Price |
$2,125.80
|
| Rate for Payer: Health Management Network Commercial |
$3,011.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,436.71
|
|
|
HC LABOR ROOM DAILY
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
1220000002
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$3,400.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,400.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,880.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HC LACOSAMIDE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 80235
|
| Hospital Charge Code |
3018023501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.95 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
|
