|
HCHG MYASTHENIA GRAVIS PANEL 2 - 90
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3011754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HCHG MYCOPHENOLIC ACID
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 80180
|
| Hospital Charge Code |
H3011617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$119.70
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$131.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$119.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$96.94
|
|
|
HCHG MYCOPHENOLIC ACID
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 80180
|
| Hospital Charge Code |
H3011617
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HCHG MYCOPLASMA PNEU AB IGM 90
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
H3020642
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HCHG MYCOPLASMA PNEU AB IGM 90
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
H3020642
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$99.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$34.24
|
|
|
HCHG MYCOPLASMA PNEU IGG AB 90
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
H3020644
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HCHG MYCOPLASMA PNEU IGG AB 90
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
H3020644
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$99.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$34.24
|
|
|
HCHG MYCOPLASMA PNEUMONIAE, PCR, QUAL - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
H3060755
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HCHG MYCOPLASMA PNEUMONIAE, PCR, QUAL - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
H3060755
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG MYELIN BASIC PROTEIN
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
H3010952
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
HCHG MYELIN BASIC PROTEIN
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
H3010952
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: AlohaCare Medicaid |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$115.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$126.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$115.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.20
|
| Rate for Payer: University Health Alliance Commercial |
$44.47
|
|
|
HCHG MYELOPEROXIDASE AB
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: AlohaCare Medicaid |
$114.00
|
| Rate for Payer: AlohaCare Medicare |
$205.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Devoted Health Medicare |
$225.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Humana Medicare |
$205.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.82
|
|
|
HCHG MYELOPEROXIDASE AB
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
|
HCHG MYOGLOBIN
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
H3010954
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG MYOGLOBIN
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
H3010954
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.92
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.37
|
|
|
HCHG MYOGLOBIN-URINE 90
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
H3010958
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG MYOGLOBIN-URINE 90
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
H3010958
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.92
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.37
|
|
|
HCHG NA QUAN NOS AGENT
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
H3060709
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
|
|
HCHG NA QUAN NOS AGENT
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
H3060709
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: AlohaCare Medicaid |
$142.50
|
| Rate for Payer: AlohaCare Medicare |
$256.50
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Devoted Health Medicare |
$282.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$53.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$256.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.84
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Humana Medicare |
$256.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$256.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$256.50
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HCHG NASAL BONES MIN 3 VIEWS
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
H3200580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$548.25 |
| Max. Negotiated Rate |
$625.65 |
| Rate for Payer: Cash Price |
$419.25
|
| Rate for Payer: Health Management Network Commercial |
$548.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$580.50
|
| Rate for Payer: MDX Hawaii PPO |
$625.65
|
|
|
HCHG NASAL BONES MIN 3 VIEWS
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
H3200580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$638.55 |
| Rate for Payer: AlohaCare Medicaid |
$322.50
|
| Rate for Payer: AlohaCare Medicare |
$580.50
|
| Rate for Payer: Cash Price |
$419.25
|
| Rate for Payer: Cash Price |
$419.25
|
| Rate for Payer: Devoted Health Medicare |
$638.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$580.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$548.25
|
| Rate for Payer: Humana Medicare |
$580.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$580.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$328.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$580.50
|
| Rate for Payer: MDX Hawaii PPO |
$625.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$580.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$580.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$580.50
|
| Rate for Payer: University Health Alliance Commercial |
$63.38
|
|
|
HCHG NASAL HEMORR ANT(CMPLX/EXTEN)
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
H4500568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$302.50
|
| Rate for Payer: AlohaCare Medicare |
$544.50
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Devoted Health Medicare |
$598.95
|
| 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 |
$544.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$574.75
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Humana Medicare |
$544.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$544.50
|
| Rate for Payer: MDX Hawaii PPO |
$586.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$544.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$544.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$544.50
|
| Rate for Payer: University Health Alliance Commercial |
$440.98
|
|
|
HCHG NASAL HEMORR ANT(CMPLX/EXTEN)
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
H4500568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$514.25 |
| Max. Negotiated Rate |
$586.85 |
| Rate for Payer: Cash Price |
$393.25
|
| Rate for Payer: Health Management Network Commercial |
$514.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$544.50
|
| Rate for Payer: MDX Hawaii PPO |
$586.85
|
|
|
HCHG NASAL HEMORR ANT SIMPLE
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
H4500570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG NASAL HEMORR ANT SIMPLE
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
H4500570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$734.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$807.84
|
| 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 |
$734.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$734.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$734.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$734.40
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
