|
HCHG PSC/BONE MARROW HARVEST WBC
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
H3050226
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HCHG PSC/BONE MARROW HARVEST WBC
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
H3050226
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$18.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Devoted Health Medicare |
$19.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$18.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.00
|
| Rate for Payer: University Health Alliance Commercial |
$6.57
|
|
|
HCHG PT ADAPT ORTHO FABRICA 15 MIN
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
H4200450
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$279.65 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$296.10
|
| Rate for Payer: MDX Hawaii PPO |
$319.13
|
|
|
HCHG PT ADAPT ORTHO FABRICA 15 MIN
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
H4200450
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: AlohaCare Medicaid |
$164.50
|
| Rate for Payer: AlohaCare Medicare |
$296.10
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Devoted Health Medicare |
$325.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$296.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$312.55
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Humana Medicare |
$296.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$296.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$296.10
|
| Rate for Payer: MDX Hawaii PPO |
$319.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$296.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$296.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$296.10
|
| Rate for Payer: University Health Alliance Commercial |
$239.81
|
|
|
HCHG PT AQUATIC THRPY 15M
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
H4200455
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$245.65 |
| Max. Negotiated Rate |
$280.33 |
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.10
|
| Rate for Payer: MDX Hawaii PPO |
$280.33
|
|
|
HCHG PT AQUATIC THRPY 15M
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS 97113
|
| Hospital Charge Code |
H4200455
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$286.11 |
| Rate for Payer: AlohaCare Medicaid |
$144.50
|
| Rate for Payer: AlohaCare Medicare |
$260.10
|
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Devoted Health Medicare |
$286.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$260.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$274.55
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Humana Medicare |
$260.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$260.10
|
| Rate for Payer: MDX Hawaii PPO |
$280.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$260.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$260.10
|
| Rate for Payer: University Health Alliance Commercial |
$210.65
|
|
|
HCHG PT ELEC STIM ATT 15 MIN
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
H4200116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
|
|
HCHG PT ELEC STIM ATT 15 MIN
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
H4200116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$117.90
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Devoted Health Medicare |
$129.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$124.45
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Humana Medicare |
$117.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.90
|
| Rate for Payer: University Health Alliance Commercial |
$95.49
|
|
|
HCHG PT ELEC STIM UNATT
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 97014
|
| Hospital Charge Code |
H4200192
|
|
Hospital Revenue Code
|
420
|
| 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 PT ELEC STIM UNATT
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 97014
|
| Hospital Charge Code |
H4200192
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.85 |
| 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 Medicare |
$114.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.65
|
| 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 |
$11.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.30
|
| Rate for Payer: University Health Alliance Commercial |
$92.57
|
|
|
HCHG PT EXERCISE 15 MIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
H4200122
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$209.88 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$190.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$209.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.40
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$190.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.80
|
| Rate for Payer: University Health Alliance Commercial |
$154.53
|
|
|
HCHG PT EXERCISE 15 MIN
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
H4200122
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
HCHG PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
H4501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.60
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
|
|
HCHG PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
H4501159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$62.00
|
| Rate for Payer: AlohaCare Medicare |
$111.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Devoted Health Medicare |
$122.76
|
| 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 |
$111.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.80
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Humana Medicare |
$111.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.60
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.60
|
| Rate for Payer: University Health Alliance Commercial |
$90.38
|
|
|
HCHG PT GAIT TRAINING 15 MIN
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 97116
|
| Hospital Charge Code |
H4200132
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
HCHG PT GAIT TRAINING 15 MIN
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 97116
|
| Hospital Charge Code |
H4200132
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$209.88 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$190.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$209.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.40
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$190.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.80
|
| Rate for Payer: University Health Alliance Commercial |
$154.53
|
|
|
HCHG PTH INTACT
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
H3010792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$517.65 |
| Max. Negotiated Rate |
$590.73 |
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$548.10
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
|
|
HCHG PTH INTACT
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
H3010792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$602.91 |
| Rate for Payer: AlohaCare Medicaid |
$304.50
|
| Rate for Payer: AlohaCare Medicare |
$548.10
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Devoted Health Medicare |
$602.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$57.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$548.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.28
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: Humana Medicare |
$548.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$548.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$310.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$548.10
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$548.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$548.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$548.10
|
| Rate for Payer: University Health Alliance Commercial |
$106.69
|
|
|
HCHG PTH, INTACT (IRMA)
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
H3011114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$602.91 |
| Rate for Payer: AlohaCare Medicaid |
$304.50
|
| Rate for Payer: AlohaCare Medicare |
$548.10
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Devoted Health Medicare |
$602.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$57.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$548.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.28
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: Humana Medicare |
$548.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$548.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$310.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$548.10
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$548.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$548.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$548.10
|
| Rate for Payer: University Health Alliance Commercial |
$106.69
|
|
|
HCHG PTH, INTACT (IRMA)
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
H3011114
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$517.65 |
| Max. Negotiated Rate |
$590.73 |
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$548.10
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
|
|
HCHG PTH-RELATED PROTEIN
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3011118
|
|
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 PTH-RELATED PROTEIN
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3011118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$135.63 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Devoted Health Medicare |
$135.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.40
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.30
|
| Rate for Payer: University Health Alliance Commercial |
$34.93
|
|
|
HCHG PT IND DAILY LIV SKILLS 15 MIN
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
H4200464
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
|
|
HCHG PT IND DAILY LIV SKILLS 15 MIN
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
H4200464
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: AlohaCare Medicaid |
$117.50
|
| Rate for Payer: AlohaCare Medicare |
$211.50
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Devoted Health Medicare |
$232.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$211.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$223.25
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Humana Medicare |
$211.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$211.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$211.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$211.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.29
|
|
|
HCHG PT (INHIBITOR SCRN)
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
H3000372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$53.10
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$58.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.29
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Humana Medicare |
$53.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.10
|
| Rate for Payer: University Health Alliance Commercial |
$10.16
|
|
