|
HCHG REPAIR BLOOD VESSEL,DIRECT,HAND,FINGER
|
Facility
|
OP
|
$8,375.00
|
|
|
Service Code
|
HCPCS 35207
|
| Hospital Charge Code |
H4500902
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$4,187.50
|
| Rate for Payer: AlohaCare Medicare |
$7,537.50
|
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Cash Price |
$5,443.75
|
| Rate for Payer: Devoted Health Medicare |
$8,291.25
|
| 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 |
$7,537.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,956.25
|
| Rate for Payer: Health Management Network Commercial |
$7,118.75
|
| Rate for Payer: Humana Medicare |
$7,537.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,537.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,537.50
|
| Rate for Payer: MDX Hawaii PPO |
$8,123.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,537.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,537.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,537.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
HCHG REPAIR EXT TENDON FINGER
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
H4500632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG REPAIR EXT TENDON FINGER
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 26418
|
| Hospital Charge Code |
H4500632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$10,679.55 |
| Rate for Payer: AlohaCare Medicaid |
$2,352.50
|
| Rate for Payer: AlohaCare Medicare |
$4,234.50
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$4,657.95
|
| 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 |
$4,234.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,234.50
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
HCHG REPAIR LACER TONGUE/MOUTH <2.6CM
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
H4500640
|
|
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 REPAIR LACER TONGUE/MOUTH <2.6CM
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 41250
|
| Hospital Charge Code |
H4500640
|
|
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 REPAIR LACER TONGUE/MOUTH >2.6CM
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
H4500642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$701.00
|
| Rate for Payer: AlohaCare Medicare |
$1,261.80
|
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Devoted Health Medicare |
$1,387.98
|
| 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 |
$1,261.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,331.90
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: Humana Medicare |
$1,261.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,261.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,261.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,261.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,261.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,261.80
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG REPAIR LACER TONGUE/MOUTH >2.6CM
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 41252
|
| Hospital Charge Code |
H4500642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,191.70 |
| Max. Negotiated Rate |
$1,359.94 |
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,261.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
|
|
HCHG REPAIR LIP FULL THICKNESS
|
Facility
|
OP
|
$2,864.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
H4500644
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,835.36 |
| Rate for Payer: AlohaCare Medicaid |
$1,432.00
|
| Rate for Payer: AlohaCare Medicare |
$2,577.60
|
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Devoted Health Medicare |
$2,835.36
|
| 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 |
$2,577.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,720.80
|
| Rate for Payer: Health Management Network Commercial |
$2,434.40
|
| Rate for Payer: Humana Medicare |
$2,577.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,577.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,577.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,778.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,577.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,577.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,577.60
|
| Rate for Payer: University Health Alliance Commercial |
$2,087.57
|
|
|
HCHG REPAIR LIP FULL THICKNESS
|
Facility
|
IP
|
$2,864.00
|
|
|
Service Code
|
HCPCS 40650
|
| Hospital Charge Code |
H4500644
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,434.40 |
| Max. Negotiated Rate |
$2,778.08 |
| Rate for Payer: Cash Price |
$1,861.60
|
| Rate for Payer: Health Management Network Commercial |
$2,434.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,577.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,778.08
|
|
|
HCHG REPAIR OF EYE WOUND
|
Facility
|
OP
|
$9,571.00
|
|
|
Service Code
|
HCPCS 65270
|
| Hospital Charge Code |
H4500984
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$9,475.29 |
| Rate for Payer: AlohaCare Medicaid |
$4,785.50
|
| Rate for Payer: AlohaCare Medicare |
$8,613.90
|
| Rate for Payer: Cash Price |
$6,221.15
|
| Rate for Payer: Cash Price |
$6,221.15
|
| Rate for Payer: Devoted Health Medicare |
$9,475.29
|
| 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 |
$8,613.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,092.45
|
| Rate for Payer: Health Management Network Commercial |
$8,135.35
|
| Rate for Payer: Humana Medicare |
$8,613.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,613.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,613.90
|
| Rate for Payer: MDX Hawaii PPO |
$9,283.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,613.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,613.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,613.90
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG REPAIR OF EYE WOUND
|
Facility
|
IP
|
$9,571.00
|
|
|
Service Code
|
HCPCS 65270
|
| Hospital Charge Code |
H4500984
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$8,135.35 |
| Max. Negotiated Rate |
$9,283.87 |
| Rate for Payer: Cash Price |
$6,221.15
|
| Rate for Payer: Health Management Network Commercial |
$8,135.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,613.90
|
| Rate for Payer: MDX Hawaii PPO |
$9,283.87
|
|
|
HCHG REPAIR OF NAIL BED
|
Facility
|
OP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
H4500650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,593.50
|
| Rate for Payer: AlohaCare Medicare |
$2,868.30
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Devoted Health Medicare |
$3,155.13
|
| 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 |
$2,868.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,027.65
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Humana Medicare |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,868.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,868.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,868.30
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG REPAIR OF NAIL BED
|
Facility
|
IP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 11760
|
| Hospital Charge Code |
H4500650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,708.95 |
| Max. Negotiated Rate |
$3,091.39 |
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
|
|
HCHG REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Facility
|
IP
|
$4,375.00
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
H4501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,718.75 |
| Max. Negotiated Rate |
$4,243.75 |
| Rate for Payer: Cash Price |
$2,843.75
|
| Rate for Payer: Health Management Network Commercial |
$3,718.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,937.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,243.75
|
|
|
HCHG REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Facility
|
OP
|
$4,375.00
|
|
|
Service Code
|
HCPCS 49451
|
| Hospital Charge Code |
H4501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,331.25 |
| Rate for Payer: AlohaCare Medicaid |
$2,187.50
|
| Rate for Payer: AlohaCare Medicare |
$3,937.50
|
| Rate for Payer: Cash Price |
$2,843.75
|
| Rate for Payer: Cash Price |
$2,843.75
|
| Rate for Payer: Devoted Health Medicare |
$4,331.25
|
| 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 |
$3,937.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,156.25
|
| Rate for Payer: Health Management Network Commercial |
$3,718.75
|
| Rate for Payer: Humana Medicare |
$3,937.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,937.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,937.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,243.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,937.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,937.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,937.50
|
| Rate for Payer: University Health Alliance Commercial |
$3,188.94
|
|
|
HCHG RESPIRATORY PANELBY FILMARRAY - 90
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
H3001125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,814.80 |
| Max. Negotiated Rate |
$4,353.36 |
| Rate for Payer: Cash Price |
$2,917.20
|
| Rate for Payer: Health Management Network Commercial |
$3,814.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,039.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,353.36
|
|
|
HCHG RESPIRATORY PANELBY FILMARRAY - 90
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
H3001125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.78 |
| Max. Negotiated Rate |
$4,443.12 |
| Rate for Payer: AlohaCare Medicaid |
$2,244.00
|
| Rate for Payer: AlohaCare Medicare |
$4,039.20
|
| Rate for Payer: Cash Price |
$2,917.20
|
| Rate for Payer: Cash Price |
$2,917.20
|
| Rate for Payer: Devoted Health Medicare |
$4,443.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$520.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,039.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,263.60
|
| Rate for Payer: Health Management Network Commercial |
$3,814.80
|
| Rate for Payer: Humana Medicare |
$4,039.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,039.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,288.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,039.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,353.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,039.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,039.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,039.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,271.30
|
|
|
HCHG RESPIRATORY PATHOGEN PNL
|
Facility
|
IP
|
$4,488.00
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
K3000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,814.80 |
| Max. Negotiated Rate |
$4,353.36 |
| Rate for Payer: Cash Price |
$2,917.20
|
| Rate for Payer: Health Management Network Commercial |
$3,814.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,039.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,353.36
|
|
|
HCHG RESPIRATORY PATHOGEN PNL
|
Facility
|
OP
|
$4,488.00
|
|
|
Service Code
|
HCPCS 0202U
|
| Hospital Charge Code |
K3000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.78 |
| Max. Negotiated Rate |
$4,443.12 |
| Rate for Payer: AlohaCare Medicaid |
$2,244.00
|
| Rate for Payer: AlohaCare Medicare |
$4,039.20
|
| Rate for Payer: Cash Price |
$2,917.20
|
| Rate for Payer: Cash Price |
$2,917.20
|
| Rate for Payer: Devoted Health Medicare |
$4,443.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$520.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,039.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,263.60
|
| Rate for Payer: Health Management Network Commercial |
$3,814.80
|
| Rate for Payer: Humana Medicare |
$4,039.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,039.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,288.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,039.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,353.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,039.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,039.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$416.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,039.20
|
| Rate for Payer: University Health Alliance Commercial |
$3,271.30
|
|
|
HCHG RESP VIRUS 6-11 TARGETS - 90
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 87632
|
| Hospital Charge Code |
H3060804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$997.05 |
| Max. Negotiated Rate |
$1,137.81 |
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Health Management Network Commercial |
$997.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,055.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,137.81
|
|
|
HCHG RESP VIRUS 6-11 TARGETS - 90
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 87632
|
| Hospital Charge Code |
H3060804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$176.02 |
| Max. Negotiated Rate |
$1,161.27 |
| Rate for Payer: AlohaCare Medicaid |
$586.50
|
| Rate for Payer: AlohaCare Medicare |
$1,055.70
|
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Devoted Health Medicare |
$1,161.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$290.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$272.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,055.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$298.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$218.06
|
| Rate for Payer: Health Management Network Commercial |
$997.05
|
| Rate for Payer: Humana Medicare |
$1,055.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,055.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$598.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,055.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,137.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,055.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,055.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,055.70
|
| Rate for Payer: University Health Alliance Commercial |
$855.00
|
|
|
HCHG RETIC COUNT
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
H3050246
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
|
|
HCHG RETIC COUNT
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
H3050246
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicare |
$27.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Devoted Health Medicare |
$29.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.99
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.00
|
| Rate for Payer: University Health Alliance Commercial |
$10.34
|
|
|
HCHG RETROGRADE URETHROGRAM
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.28 |
| Max. Negotiated Rate |
$1,330.56 |
| Rate for Payer: AlohaCare Medicaid |
$672.00
|
| Rate for Payer: AlohaCare Medicare |
$1,209.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Devoted Health Medicare |
$1,330.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,209.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.43
|
| Rate for Payer: Health Management Network Commercial |
$1,142.40
|
| Rate for Payer: Humana Medicare |
$1,209.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,209.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$685.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,209.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,303.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,209.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,209.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,209.60
|
| Rate for Payer: University Health Alliance Commercial |
$159.90
|
|
|
HCHG RETROGRADE URETHROGRAM
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,142.40 |
| Max. Negotiated Rate |
$1,303.68 |
| Rate for Payer: Cash Price |
$873.60
|
| Rate for Payer: Health Management Network Commercial |
$1,142.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,209.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,303.68
|
|
