|
HCHG PUNCT ASP ABSC/HEMA/BULLA/CYST
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
H4500590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,123.00
|
| Rate for Payer: AlohaCare Medicare |
$2,021.40
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$2,223.54
|
| 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 |
$2,021.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,021.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,021.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,021.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG PUNCT ASP ABSC/HEMA/BULLA/CYST
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
H4500590
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
H4501072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,465.85 |
| Max. Negotiated Rate |
$2,813.97 |
| Rate for Payer: Cash Price |
$1,885.65
|
| Rate for Payer: Health Management Network Commercial |
$2,465.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,610.90
|
| Rate for Payer: MDX Hawaii PPO |
$2,813.97
|
|
|
HCHG PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
H4501072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,871.99 |
| Rate for Payer: AlohaCare Medicaid |
$1,450.50
|
| Rate for Payer: AlohaCare Medicare |
$2,610.90
|
| Rate for Payer: Cash Price |
$1,885.65
|
| Rate for Payer: Cash Price |
$1,885.65
|
| Rate for Payer: Devoted Health Medicare |
$2,871.99
|
| 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 |
$2,610.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,755.95
|
| Rate for Payer: Health Management Network Commercial |
$2,465.85
|
| Rate for Payer: Humana Medicare |
$2,610.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,610.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,610.90
|
| Rate for Payer: MDX Hawaii PPO |
$2,813.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,610.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,610.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,610.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,114.54
|
|
|
HCHG PYRUVATE KINASE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 84220
|
| Hospital Charge Code |
H3011388
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Devoted Health Medicare |
$71.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$64.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.80
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HCHG PYRUVATE KINASE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 84220
|
| Hospital Charge Code |
H3011388
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
|
|
HCHG Q FEVER IGG PHASE II TITER
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020974
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG Q FEVER IGG PHASE II TITER
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020974
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
HCHG Q FEVER IGG PHASE I TITER
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020973
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG Q FEVER IGG PHASE I TITER
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020973
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
HCHG QUAD COUGH INIT
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4100182
|
|
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 QUAD COUGH INIT
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4100182
|
|
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 QUAD COUGH SUBSEQ
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
H4100183
|
|
Hospital Revenue Code
|
412
|
| 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 QUAD COUGH SUBSEQ
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
H4100183
|
|
Hospital Revenue Code
|
412
|
| 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 QUANTIFERON-TB GOLD
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
H3020904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.95 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: AlohaCare Medicaid |
$190.00
|
| Rate for Payer: AlohaCare Medicare |
$342.00
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Devoted Health Medicare |
$376.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$342.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.98
|
| Rate for Payer: Health Management Network Commercial |
$323.00
|
| Rate for Payer: Humana Medicare |
$342.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$342.00
|
| Rate for Payer: MDX Hawaii PPO |
$368.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$342.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$342.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$342.00
|
| Rate for Payer: University Health Alliance Commercial |
$160.19
|
|
|
HCHG QUANTIFERON-TB GOLD
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 86480
|
| Hospital Charge Code |
H3020904
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$323.00 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Health Management Network Commercial |
$323.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$342.00
|
| Rate for Payer: MDX Hawaii PPO |
$368.60
|
|
|
HCHG RA FACTOR-BODY FLD QUANT
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
|
|
HCHG RA FACTOR-BODY FLD QUANT
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$105.93 |
| Rate for Payer: AlohaCare Medicaid |
$53.50
|
| Rate for Payer: AlohaCare Medicare |
$96.30
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Devoted Health Medicare |
$105.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.67
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Humana Medicare |
$96.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$96.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$96.30
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$96.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.30
|
| Rate for Payer: University Health Alliance Commercial |
$14.67
|
|
|
HCHG RAPID DIR GRP-A STREP SCREEN
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
H3060666
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
HCHG RAPID DIR GRP-A STREP SCREEN
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
H3060666
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$177.21 |
| Rate for Payer: AlohaCare Medicaid |
$89.50
|
| Rate for Payer: AlohaCare Medicare |
$161.10
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$177.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$161.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.10
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG RAPID MOLECULAR PRENATAL GBS SCREEN
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
H3060648
|
|
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 RAPID MOLECULAR PRENATAL GBS SCREEN
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
H3060648
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| 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 |
$49.04
|
| 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 |
$51.49
|
| 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 |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG REDUCTION OF PROCIDENTIA UNDER ANESTH
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
H4501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,936.35 |
| Max. Negotiated Rate |
$4,492.07 |
| Rate for Payer: Cash Price |
$3,010.15
|
| Rate for Payer: Health Management Network Commercial |
$3,936.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,167.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,492.07
|
|
|
HCHG REDUCTION OF PROCIDENTIA UNDER ANESTH
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
H4501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,584.69 |
| Rate for Payer: AlohaCare Medicaid |
$2,315.50
|
| Rate for Payer: AlohaCare Medicare |
$4,167.90
|
| Rate for Payer: Cash Price |
$3,010.15
|
| Rate for Payer: Cash Price |
$3,010.15
|
| Rate for Payer: Devoted Health Medicare |
$4,584.69
|
| 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 |
$4,167.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,399.45
|
| Rate for Payer: Health Management Network Commercial |
$3,936.35
|
| Rate for Payer: Humana Medicare |
$4,167.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,167.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,167.90
|
| Rate for Payer: MDX Hawaii PPO |
$4,492.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,167.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,167.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,167.90
|
| Rate for Payer: University Health Alliance Commercial |
$3,375.54
|
|
|
HCHG REMOVAL FOREIGN BODY INTRAOCCULAR
|
Facility
|
IP
|
$7,820.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
H4501119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,647.00 |
| Max. Negotiated Rate |
$7,585.40 |
| Rate for Payer: Cash Price |
$5,083.00
|
| Rate for Payer: Health Management Network Commercial |
$6,647.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,038.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,585.40
|
|
