|
HCHG MANDIBLE COMP MIN 4 VIEWS
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
H3200556
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
HCHG MANDIBLE COMP MIN 4 VIEWS
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
H3200556
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$750.42 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$682.20
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$750.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$682.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$682.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.20
|
| Rate for Payer: University Health Alliance Commercial |
$78.16
|
|
|
HCHG MANIPULATION CHEST WALL INITIAL
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4100278
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$408.87 |
| Rate for Payer: AlohaCare Medicaid |
$206.50
|
| Rate for Payer: AlohaCare Medicare |
$371.70
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Devoted Health Medicare |
$408.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$371.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$392.35
|
| Rate for Payer: Health Management Network Commercial |
$351.05
|
| Rate for Payer: Humana Medicare |
$371.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$371.70
|
| Rate for Payer: MDX Hawaii PPO |
$400.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$371.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$371.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$371.70
|
| Rate for Payer: University Health Alliance Commercial |
$301.04
|
|
|
HCHG MANIPULATION CHEST WALL INITIAL
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4100278
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$351.05 |
| Max. Negotiated Rate |
$400.61 |
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Health Management Network Commercial |
$351.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.70
|
| Rate for Payer: MDX Hawaii PPO |
$400.61
|
|
|
HCHG MANIPULATION CHEST WALL SUBSQ
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
H4100275
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.00
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
|
|
HCHG MANIPULATION CHEST WALL SUBSQ
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
H4100275
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: AlohaCare Medicaid |
$125.00
|
| Rate for Payer: AlohaCare Medicare |
$225.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$247.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$225.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$225.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.00
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.22
|
|
|
HCHG MANUAL DIFF
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
K3050002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
HCHG MANUAL DIFF
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
K3050002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$66.33 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$60.30
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$66.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$60.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.30
|
| Rate for Payer: University Health Alliance Commercial |
$8.90
|
|
|
HCHG MANUAL THERAPY 15 MIN
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
H4300116
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$195.03 |
| Rate for Payer: AlohaCare Medicaid |
$98.50
|
| Rate for Payer: AlohaCare Medicare |
$177.30
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Devoted Health Medicare |
$195.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.15
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Humana Medicare |
$177.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.30
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.30
|
| Rate for Payer: University Health Alliance Commercial |
$143.59
|
|
|
HCHG MANUAL THERAPY 15 MIN
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
H4300116
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$167.45 |
| Max. Negotiated Rate |
$191.09 |
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
|
|
HCHG M.AVIUM COMPLEX MIC PANEL
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060681
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$315.81 |
| Rate for Payer: AlohaCare Medicaid |
$159.50
|
| Rate for Payer: AlohaCare Medicare |
$287.10
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Devoted Health Medicare |
$315.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Humana Medicare |
$287.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$287.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.10
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HCHG M.AVIUM COMPLEX MIC PANEL
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060681
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
|
|
HCHG MDI TX INIT
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
H4120208
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$430.65 |
| Rate for Payer: AlohaCare Medicaid |
$217.50
|
| Rate for Payer: AlohaCare Medicare |
$391.50
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: Devoted Health Medicare |
$430.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$391.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$413.25
|
| Rate for Payer: Health Management Network Commercial |
$369.75
|
| Rate for Payer: Humana Medicare |
$391.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.50
|
| Rate for Payer: MDX Hawaii PPO |
$421.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$391.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$391.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$391.50
|
| Rate for Payer: University Health Alliance Commercial |
$317.07
|
|
|
HCHG MDI TX INIT
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
H4120208
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$369.75 |
| Max. Negotiated Rate |
$421.95 |
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: Health Management Network Commercial |
$369.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.50
|
| Rate for Payer: MDX Hawaii PPO |
$421.95
|
|
|
HCHG MDI TX SUBSEQ
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4120210
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG MDI TX SUBSEQ
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4120210
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,243.44 |
| Rate for Payer: AlohaCare Medicaid |
$628.00
|
| Rate for Payer: AlohaCare Medicare |
$1,130.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Devoted Health Medicare |
$1,243.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,193.20
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Humana Medicare |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$640.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.40
|
| Rate for Payer: University Health Alliance Commercial |
$915.50
|
|
|
HCHG MDI VENT TX DEMO//EVAL
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
H4100154
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$430.65 |
| Rate for Payer: AlohaCare Medicaid |
$217.50
|
| Rate for Payer: AlohaCare Medicare |
$391.50
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: Devoted Health Medicare |
$430.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$391.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$413.25
|
| Rate for Payer: Health Management Network Commercial |
$369.75
|
| Rate for Payer: Humana Medicare |
$391.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$391.50
|
| Rate for Payer: MDX Hawaii PPO |
$421.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$391.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$391.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$391.50
|
| Rate for Payer: University Health Alliance Commercial |
$317.07
|
|
|
HCHG MDI VENT TX DEMO//EVAL
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
H4100154
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$369.75 |
| Max. Negotiated Rate |
$421.95 |
| Rate for Payer: Cash Price |
$282.75
|
| Rate for Payer: Health Management Network Commercial |
$369.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$391.50
|
| Rate for Payer: MDX Hawaii PPO |
$421.95
|
|
|
HCHG META NEB COMBO TX, DAILY
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100294
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG META NEB COMBO TX, DAILY
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100294
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,243.44 |
| Rate for Payer: AlohaCare Medicaid |
$628.00
|
| Rate for Payer: AlohaCare Medicare |
$1,130.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Devoted Health Medicare |
$1,243.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,193.20
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Humana Medicare |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$640.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.40
|
| Rate for Payer: University Health Alliance Commercial |
$915.50
|
|
|
HCHG META NEB COMBO TX, SUBSEQUENT
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100295
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,243.44 |
| Rate for Payer: AlohaCare Medicaid |
$628.00
|
| Rate for Payer: AlohaCare Medicare |
$1,130.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Devoted Health Medicare |
$1,243.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,193.20
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Humana Medicare |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$640.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.40
|
| Rate for Payer: University Health Alliance Commercial |
$915.50
|
|
|
HCHG META NEB COMBO TX, SUBSEQUENT
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100295
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG METANEPHRINE 24 HR URINE
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
H3010878
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$114.30
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$125.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.94
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$114.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.30
|
| Rate for Payer: University Health Alliance Commercial |
$43.79
|
|
|
HCHG METANEPHRINE 24 HR URINE
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
H3010878
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
HCHG METANEPHRINE PLASMA
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
H3010880
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$114.30
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$125.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.94
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$114.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.30
|
| Rate for Payer: University Health Alliance Commercial |
$43.79
|
|
