|
HCHG RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 36584
|
| Hospital Charge Code |
H4501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,392.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,557.03
|
|
|
HCHG RSV AG EIA
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
H3060458
|
|
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 RSV AG EIA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
H3060458
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| 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 |
$7.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.39
|
| 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 |
$7.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$13.88
|
|
|
HCHG RSVP AM PROBE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
K3060036
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$774.18 |
| Rate for Payer: AlohaCare Medicaid |
$391.00
|
| Rate for Payer: AlohaCare Medicare |
$703.80
|
| Rate for Payer: Cash Price |
$508.30
|
| Rate for Payer: Cash Price |
$508.30
|
| Rate for Payer: Devoted Health Medicare |
$774.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$703.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network Commercial |
$664.70
|
| Rate for Payer: Humana Medicare |
$703.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$703.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$398.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$703.80
|
| Rate for Payer: MDX Hawaii PPO |
$758.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$703.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$703.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$703.80
|
| Rate for Payer: University Health Alliance Commercial |
$160.32
|
|
|
HCHG RSVP AM PROBE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
K3060036
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$664.70 |
| Max. Negotiated Rate |
$758.54 |
| Rate for Payer: Cash Price |
$508.30
|
| Rate for Payer: Health Management Network Commercial |
$664.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$703.80
|
| Rate for Payer: MDX Hawaii PPO |
$758.54
|
|
|
HCHG RSV, RNA, REAL-TIME PCR
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060663
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$410.55 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
|
|
HCHG RSV, RNA, REAL-TIME PCR
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060663
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$478.17 |
| Rate for Payer: AlohaCare Medicaid |
$241.50
|
| Rate for Payer: AlohaCare Medicare |
$434.70
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Devoted Health Medicare |
$478.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Humana Medicare |
$434.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.70
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG RUBELLA AB IGG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
H3020760
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: AlohaCare Medicaid |
$55.00
|
| Rate for Payer: AlohaCare Medicare |
$99.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$108.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$99.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HCHG RUBELLA AB IGG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
H3020760
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
HCHG RUBELLA AB IGM 90
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
H3020762
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
HCHG RUBELLA AB IGM 90
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
H3020762
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: AlohaCare Medicaid |
$55.00
|
| Rate for Payer: AlohaCare Medicare |
$99.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$108.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$99.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HCHG RUBEOLA AB IGG
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
H3020764
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG RUBEOLA AB IGG
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
H3020764
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG RUBEOLA AB IGM 90
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
H3020766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG RUBEOLA AB IGM 90
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
H3020766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG SACROCOC SPINE, MIN 2 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
H3200728
|
|
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 SACROCOC SPINE, MIN 2 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
H3200728
|
|
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 |
$62.01
|
|
|
HCHG SACROILIACS, 3 OR MORE VIEWS
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
H3200730
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$577.17 |
| Rate for Payer: AlohaCare Medicaid |
$291.50
|
| Rate for Payer: AlohaCare Medicare |
$524.70
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Devoted Health Medicare |
$577.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$524.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$495.55
|
| Rate for Payer: Humana Medicare |
$524.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$524.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$297.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$524.70
|
| Rate for Payer: MDX Hawaii PPO |
$565.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$524.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$524.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$524.70
|
| Rate for Payer: University Health Alliance Commercial |
$71.43
|
|
|
HCHG SACROILIACS, 3 OR MORE VIEWS
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
HCPCS 72202
|
| Hospital Charge Code |
H3200730
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$495.55 |
| Max. Negotiated Rate |
$565.51 |
| Rate for Payer: Cash Price |
$378.95
|
| Rate for Payer: Health Management Network Commercial |
$495.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$524.70
|
| Rate for Payer: MDX Hawaii PPO |
$565.51
|
|
|
HCHG SACRUM AND COCCYX, MIN 2 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
H3200286
|
|
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 |
$62.01
|
|
|
HCHG SACRUM AND COCCYX, MIN 2 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 72220
|
| Hospital Charge Code |
H3200286
|
|
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 SALICYLATES
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
H3011723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$136.62 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicare |
$124.20
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$136.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$124.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.20
|
| Rate for Payer: University Health Alliance Commercial |
$100.59
|
|
|
HCHG SALICYLATES
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 80179
|
| Hospital Charge Code |
H3011723
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
HCHG SALICYLATES BLOOD
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$692.01 |
| Rate for Payer: AlohaCare Medicaid |
$349.50
|
| Rate for Payer: AlohaCare Medicare |
$629.10
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$692.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$629.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Humana Medicare |
$629.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$629.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$629.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$629.10
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HCHG SALICYLATES BLOOD
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
