|
HCHG REMOVE FB EAR WO ANESTH
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
H4500594
|
|
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 REMOVE FB EAR WO ANESTH
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
H4500594
|
|
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
|
|
|
HCHG REMOVE FB FOOT SUBQ
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
H4500598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,796.00
|
| Rate for Payer: AlohaCare Medicare |
$3,232.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Devoted Health Medicare |
$3,556.08
|
| 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 |
$3,232.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,412.40
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Humana Medicare |
$3,232.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,232.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,232.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,232.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,232.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,232.80
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG REMOVE FB FOOT SUBQ
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
H4500598
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,232.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
|
|
HCHG REMOVE FB INTRANASAL
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
H4500610
|
|
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
|
|
|
HCHG REMOVE FB INTRANASAL
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
H4500610
|
|
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 REMOVE FB PHARYNX
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
H4500612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,907.40 |
| Max. Negotiated Rate |
$2,176.68 |
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Health Management Network Commercial |
$1,907.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,019.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,176.68
|
|
|
HCHG REMOVE FB PHARYNX
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
H4500612
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,221.56 |
| Rate for Payer: AlohaCare Medicaid |
$1,122.00
|
| Rate for Payer: AlohaCare Medicare |
$2,019.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Devoted Health Medicare |
$2,221.56
|
| 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 |
$2,019.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,131.80
|
| Rate for Payer: Health Management Network Commercial |
$1,907.40
|
| Rate for Payer: Humana Medicare |
$2,019.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,019.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,019.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,176.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,019.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,019.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,019.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,635.65
|
|
|
HCHG REMOVE IMPACTED CERUMEN UNILAT
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
H4500614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$385.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$423.72
|
| 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 |
$385.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$385.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.20
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG REMOVE IMPACTED CERUMEN UNILAT
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 69210
|
| Hospital Charge Code |
H4500614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
HCHG REMOVE IMPL VA DEVICE/SUBQ RESV
|
Facility
|
OP
|
$2,008.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
H4500616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,987.92 |
| Rate for Payer: AlohaCare Medicaid |
$1,004.00
|
| Rate for Payer: AlohaCare Medicare |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,305.20
|
| Rate for Payer: Cash Price |
$1,305.20
|
| Rate for Payer: Devoted Health Medicare |
$1,987.92
|
| 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 |
$1,807.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,907.60
|
| Rate for Payer: Health Management Network Commercial |
$1,706.80
|
| Rate for Payer: Humana Medicare |
$1,807.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,807.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,807.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,947.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,807.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,807.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,807.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,463.63
|
|
|
HCHG REMOVE IMPL VA DEVICE/SUBQ RESV
|
Facility
|
IP
|
$2,008.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
H4500616
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,706.80 |
| Max. Negotiated Rate |
$1,947.76 |
| Rate for Payer: Cash Price |
$1,305.20
|
| Rate for Payer: Health Management Network Commercial |
$1,706.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,807.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,947.76
|
|
|
HCHG REMOVE NAIL & MATRIX PERM
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
H4500618
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,223.54 |
| 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 |
$1,637.11
|
|
|
HCHG REMOVE NAIL & MATRIX PERM
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
H4500618
|
|
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 REMOVE OF IMPLANT SUPERFIC
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
H4500622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,869.81 |
| Rate for Payer: AlohaCare Medicaid |
$2,459.50
|
| Rate for Payer: AlohaCare Medicare |
$4,427.10
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Devoted Health Medicare |
$4,869.81
|
| 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 |
$4,427.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,673.05
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: Humana Medicare |
$4,427.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,427.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,427.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,427.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,427.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,427.10
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG REMOVE OF IMPLANT SUPERFIC
|
Facility
|
IP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
H4500622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,181.15 |
| Max. Negotiated Rate |
$4,771.43 |
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,427.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
|
|
HCHG REMOVE TUNN VAD W SUBQ
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
H4500859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,148.00 |
| Max. Negotiated Rate |
$4,733.60 |
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Health Management Network Commercial |
$4,148.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,392.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,733.60
|
|
|
HCHG REMOVE TUNN VAD W SUBQ
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
H4500859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,831.20 |
| Rate for Payer: AlohaCare Medicaid |
$2,440.00
|
| Rate for Payer: AlohaCare Medicare |
$4,392.00
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Devoted Health Medicare |
$4,831.20
|
| 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 |
$4,392.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,636.00
|
| Rate for Payer: Health Management Network Commercial |
$4,148.00
|
| Rate for Payer: Humana Medicare |
$4,392.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,392.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,392.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,733.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,392.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,392.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,392.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,557.03
|
|
|
HCHG RENAL PROFILE
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
H3011132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
HCHG RENAL PROFILE
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 80069
|
| Hospital Charge Code |
H3011132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: AlohaCare Medicaid |
$72.00
|
| Rate for Payer: AlohaCare Medicare |
$129.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$142.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.68
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$129.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.60
|
| Rate for Payer: University Health Alliance Commercial |
$22.44
|
|
|
HCHG RENIN
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.99
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
|
|
HCHG RENIN
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG RENIN ACTIVITY PLASMA
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG RENIN ACTIVITY PLASMA
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
H3011134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.99
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
|
|
HCHG REPAIR BLOOD VESSEL,DIRECT,HAND,FINGER
|
Facility
|
IP
|
$8,375.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
H4500902
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,118.75 |
| Max. Negotiated Rate |
$8,123.75 |
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Health Management Network Commercial |
$7,118.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,537.50
|
| Rate for Payer: MDX Hawaii PPO |
$8,123.75
|
|
