|
HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
4027683001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$230.73
|
|
|
HC ECHOGRAPHY,TRANSVAGINAL - US PELVIS TRANSVAGINAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
4027683001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC ECHO HEART XTHORACIC,LIMITED
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4839330801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$817.70 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$865.80
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
|
|
HC ECHO HEART XTHORACIC,LIMITED
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
4839330801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.22 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$481.00
|
| Rate for Payer: AlohaCare Medicare |
$298.22
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$327.08
|
| 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 |
$298.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.90
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Humana Medicare |
$298.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$865.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.22
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$298.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$298.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$298.22
|
| Rate for Payer: University Health Alliance Commercial |
$701.20
|
|
|
HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
4027685601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC ECHO,PELVIC (NONOBSTETRIC) - US PELVIS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
4027685601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$231.53
|
|
|
HC ECHO,SCROTUM & CONTENTS - US SCROTUM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
4027687001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC ECHO,SCROTUM & CONTENTS - US SCROTUM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
4027687001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$228.81
|
|
|
HC ECHO STRESS TRANSTHORASIC
|
Facility
|
IP
|
$2,728.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
4839335001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,318.80 |
| Max. Negotiated Rate |
$2,646.16 |
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Health Management Network Commercial |
$2,318.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,455.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,646.16
|
|
|
HC ECHO STRESS TRANSTHORASIC
|
Facility
|
OP
|
$2,728.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
4839335001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$2,646.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,364.00
|
| Rate for Payer: AlohaCare Medicare |
$845.68
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Cash Price |
$1,636.80
|
| Rate for Payer: Devoted Health Medicare |
$927.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$845.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,591.60
|
| Rate for Payer: Health Management Network Commercial |
$2,318.80
|
| Rate for Payer: Humana Medicare |
$845.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,455.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,391.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$845.68
|
| Rate for Payer: MDX Hawaii PPO |
$2,646.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$845.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$845.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$845.68
|
| Rate for Payer: University Health Alliance Commercial |
$1,988.44
|
|
|
HC ELECTROCARDIOGRAM, TRACING
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$73.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$80.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$73.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.16
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC ELECTROCARDIOGRAM, TRACING
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC ELECTROLYTE PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
3018005101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
|
|
HC ELECTROLYTE PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
3018005101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$18.29
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Devoted Health Medicare |
$20.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.01
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.29
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.29
|
| Rate for Payer: University Health Alliance Commercial |
$18.13
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
4509928101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$236.22
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Devoted Health Medicare |
$259.08
|
| 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 |
$236.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$723.90
|
| Rate for Payer: Health Management Network Commercial |
$647.70
|
| Rate for Payer: Humana Medicare |
$236.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$685.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.22
|
| Rate for Payer: MDX Hawaii PPO |
$739.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$236.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$236.22
|
| Rate for Payer: University Health Alliance Commercial |
$555.42
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
4509928101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$647.70 |
| Max. Negotiated Rate |
$739.14 |
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Health Management Network Commercial |
$647.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$685.80
|
| Rate for Payer: MDX Hawaii PPO |
$739.14
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$409.51
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Devoted Health Medicare |
$449.14
|
| 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 |
$409.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,254.95
|
| Rate for Payer: Health Management Network Commercial |
$1,122.85
|
| Rate for Payer: Humana Medicare |
$409.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$409.51
|
| Rate for Payer: MDX Hawaii PPO |
$1,281.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$409.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$409.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$409.51
|
| Rate for Payer: University Health Alliance Commercial |
$962.88
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,122.85 |
| Max. Negotiated Rate |
$1,281.37 |
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Health Management Network Commercial |
$1,122.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,281.37
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Facility
|
IP
|
$2,930.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,490.50 |
| Max. Negotiated Rate |
$2,842.10 |
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Health Management Network Commercial |
$2,490.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,637.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,842.10
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Facility
|
OP
|
$2,930.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$2,842.10 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$908.30
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Devoted Health Medicare |
$996.20
|
| 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 |
$908.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,783.50
|
| Rate for Payer: Health Management Network Commercial |
$2,490.50
|
| Rate for Payer: Humana Medicare |
$908.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,637.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$908.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,842.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$908.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$908.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$908.30
|
| Rate for Payer: University Health Alliance Commercial |
$2,135.68
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Facility
|
OP
|
$4,272.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$4,143.84 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$1,324.32
|
| Rate for Payer: Cash Price |
$2,563.20
|
| Rate for Payer: Cash Price |
$2,563.20
|
| Rate for Payer: Cash Price |
$2,563.20
|
| Rate for Payer: Devoted Health Medicare |
$1,452.48
|
| 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 |
$1,324.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,058.40
|
| Rate for Payer: Health Management Network Commercial |
$3,631.20
|
| Rate for Payer: Humana Medicare |
$1,324.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,844.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,324.32
|
| Rate for Payer: MDX Hawaii PPO |
$4,143.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,324.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,324.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,324.32
|
| Rate for Payer: University Health Alliance Commercial |
$3,113.86
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Facility
|
IP
|
$4,272.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,631.20 |
| Max. Negotiated Rate |
$4,143.84 |
| Rate for Payer: Cash Price |
$2,563.20
|
| Rate for Payer: Health Management Network Commercial |
$3,631.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,844.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,143.84
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
IP
|
$4,879.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,147.15 |
| Max. Negotiated Rate |
$4,732.63 |
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Health Management Network Commercial |
$4,147.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,391.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,732.63
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
OP
|
$4,879.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$4,732.63 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$1,512.49
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Devoted Health Medicare |
$1,658.86
|
| 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 |
$1,512.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,635.05
|
| Rate for Payer: Health Management Network Commercial |
$4,147.15
|
| Rate for Payer: Humana Medicare |
$1,512.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,391.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,512.49
|
| Rate for Payer: MDX Hawaii PPO |
$4,732.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,512.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,512.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,512.49
|
| Rate for Payer: University Health Alliance Commercial |
$3,556.30
|
|
|
HC ESCHAROTOMY
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
7611603501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$492.90
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$540.60
|
| 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 |
$492.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$492.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
