|
HCHG RETRO PYELOGRAM PORT
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200700
|
|
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 RETRO PYELOGRAM PORT
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200700
|
|
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
|
|
|
HCHG RHEUMATOID FACTOR QUANT
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020750
|
|
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 RHEUMATOID FACTOR QUANT
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020750
|
|
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 RH FACTOR
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020746
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
|
|
HCHG RH FACTOR
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020746
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: AlohaCare Medicaid |
$31.00
|
| Rate for Payer: AlohaCare Medicare |
$55.80
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Devoted Health Medicare |
$61.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Humana Medicare |
$55.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.80
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HCHG RHYTHM STRIP EXTEND, TRACING ONLY
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
H7300116
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$248.32 |
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$230.40
|
| Rate for Payer: MDX Hawaii PPO |
$248.32
|
|
|
HCHG RHYTHM STRIP EXTEND, TRACING ONLY
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
H7300116
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$253.44 |
| Rate for Payer: AlohaCare Medicaid |
$128.00
|
| Rate for Payer: AlohaCare Medicare |
$230.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Devoted Health Medicare |
$253.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$230.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.20
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Humana Medicare |
$230.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$230.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$230.40
|
| Rate for Payer: MDX Hawaii PPO |
$248.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$230.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$230.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$230.40
|
| Rate for Payer: University Health Alliance Commercial |
$186.60
|
|
|
HCHG RIBS BIL W CHEST MIN 4VW
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
H3200710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$750.42 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$682.20
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$750.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$682.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$682.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.20
|
| Rate for Payer: University Health Alliance Commercial |
$105.84
|
|
|
HCHG RIBS BIL W CHEST MIN 4VW
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
H3200710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
HCHG RIBS UNILAT 2 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
H3200918
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$597.96 |
| Rate for Payer: AlohaCare Medicaid |
$302.00
|
| Rate for Payer: AlohaCare Medicare |
$543.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Devoted Health Medicare |
$597.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Humana Medicare |
$543.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$66.43
|
|
|
HCHG RIBS UNILAT 2 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
H3200918
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
|
|
HCHG RIBS UNI W CHEST MIN 3 VIEWS
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
H3200714
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG RIBS UNI W CHEST MIN 3 VIEWS
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
H3200714
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$80.36
|
|
|
HCHG RMVL SUTURES OR STAPLES WO ANESTHESIA
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
H4501167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.55 |
| Max. Negotiated Rate |
$255.11 |
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Health Management Network Commercial |
$223.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.70
|
| Rate for Payer: MDX Hawaii PPO |
$255.11
|
|
|
HCHG RMVL SUTURES OR STAPLES WO ANESTHESIA
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
H4501167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$131.50
|
| Rate for Payer: AlohaCare Medicare |
$236.70
|
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Cash Price |
$170.95
|
| Rate for Payer: Devoted Health Medicare |
$260.37
|
| 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 |
$236.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$249.85
|
| Rate for Payer: Health Management Network Commercial |
$223.55
|
| Rate for Payer: Humana Medicare |
$236.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.70
|
| Rate for Payer: MDX Hawaii PPO |
$255.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$236.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$236.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$236.70
|
| Rate for Payer: University Health Alliance Commercial |
$191.70
|
|
|
HCHG RMVL SUTURES & STAPLES WO ANESTHESIA
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
H4501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
|
|
HCHG RMVL SUTURES & STAPLES WO ANESTHESIA
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
H4501168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$123.00
|
| Rate for Payer: AlohaCare Medicare |
$221.40
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Devoted Health Medicare |
$243.54
|
| 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 |
$221.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$233.70
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Humana Medicare |
$221.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.40
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.40
|
| Rate for Payer: University Health Alliance Commercial |
$179.31
|
|
|
HCHG ROTAVIRUS AG EIA
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
H3060356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG ROTAVIRUS AG EIA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
H3060356
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG RPLC GTUBE NO REVJ TRC
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
H4501136
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,198.50 |
| Max. Negotiated Rate |
$1,367.70 |
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
|
|
HCHG RPLC GTUBE NO REVJ TRC
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 43762
|
| Hospital Charge Code |
H4501136
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$705.00
|
| Rate for Payer: AlohaCare Medicare |
$1,269.00
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$1,395.90
|
| 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 |
$1,269.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,339.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Humana Medicare |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,269.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,269.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,269.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,027.75
|
|
|
HCHG RPLC GTUBE REVJ GSTRST TRC
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
H4501137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,198.50 |
| Max. Negotiated Rate |
$1,367.70 |
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
|
|
HCHG RPLC GTUBE REVJ GSTRST TRC
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 43763
|
| Hospital Charge Code |
H4501137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$705.00
|
| Rate for Payer: AlohaCare Medicare |
$1,269.00
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$1,395.90
|
| 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 |
$1,269.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,339.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Humana Medicare |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,269.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,269.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,269.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,027.75
|
|
|
HCHG RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
H4501088
|
|
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
|
|
