|
HCHG SHOULDER MIN 2 VIEWS PORT
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200750
|
|
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 |
$61.92
|
|
|
HCHG SHOULDER MIN 2 VIEWS PORT
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200750
|
|
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 SICKLE CELL SCRN 90
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
H3050250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HCHG SICKLE CELL SCRN 90
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
H3050250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$37.80
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Devoted Health Medicare |
$41.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$37.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.80
|
| Rate for Payer: University Health Alliance Commercial |
$14.26
|
|
|
HCHG SINUSES < 3 VIEWS
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
H3200610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.35 |
| Max. Negotiated Rate |
$437.47 |
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.90
|
| Rate for Payer: MDX Hawaii PPO |
$437.47
|
|
|
HCHG SINUSES < 3 VIEWS
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
H3200610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$446.49 |
| Rate for Payer: AlohaCare Medicaid |
$225.50
|
| Rate for Payer: AlohaCare Medicare |
$405.90
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Devoted Health Medicare |
$446.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Humana Medicare |
$405.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$230.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.90
|
| Rate for Payer: MDX Hawaii PPO |
$437.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.90
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG SIROLIMUS, WHOLE BLOOD - 90
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
H3011752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$86.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$95.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.73
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$86.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.40
|
| Rate for Payer: University Health Alliance Commercial |
$35.46
|
|
|
HCHG SIROLIMUS, WHOLE BLOOD - 90
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
H3011752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
HCHG SJOGREN'S AB SSA 90
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HCHG SJOGREN'S AB SSA 90
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$119.70
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$131.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$119.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HCHG SJOGREN'S AB SSB 90
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HCHG SJOGREN'S AB SSB 90
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$119.70
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$131.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$119.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HCHG SKULL 1-3 VIEWS
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
H3200758
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$521.90 |
| Max. Negotiated Rate |
$595.58 |
| Rate for Payer: Cash Price |
$399.10
|
| Rate for Payer: Health Management Network Commercial |
$521.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$552.60
|
| Rate for Payer: MDX Hawaii PPO |
$595.58
|
|
|
HCHG SKULL 1-3 VIEWS
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
H3200758
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$607.86 |
| Rate for Payer: AlohaCare Medicaid |
$307.00
|
| Rate for Payer: AlohaCare Medicare |
$552.60
|
| Rate for Payer: Cash Price |
$399.10
|
| Rate for Payer: Cash Price |
$399.10
|
| Rate for Payer: Devoted Health Medicare |
$607.86
|
| 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 |
$552.60
|
| 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 |
$521.90
|
| Rate for Payer: Humana Medicare |
$552.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$552.60
|
| Rate for Payer: MDX Hawaii PPO |
$595.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$552.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$552.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$552.60
|
| Rate for Payer: University Health Alliance Commercial |
$72.65
|
|
|
HCHG SKULL 1-3 VIEWS PORT
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
H3200760
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$700.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$637.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$700.92
|
| 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 |
$637.20
|
| 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 |
$601.80
|
| Rate for Payer: Humana Medicare |
$637.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$637.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.20
|
| Rate for Payer: University Health Alliance Commercial |
$72.65
|
|
|
HCHG SKULL 1-3 VIEWS PORT
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 70250
|
| Hospital Charge Code |
H3200760
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG SKULL 4-5 VIEWS
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
H3200762
|
|
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 |
$100.57
|
|
|
HCHG SKULL 4-5 VIEWS
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 70260
|
| Hospital Charge Code |
H3200762
|
|
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 SKULL - WATERS ONLY < 3 VIEWS
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
H3200915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.35 |
| Max. Negotiated Rate |
$437.47 |
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.90
|
| Rate for Payer: MDX Hawaii PPO |
$437.47
|
|
|
HCHG SKULL - WATERS ONLY < 3 VIEWS
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
H3200915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$446.49 |
| Rate for Payer: AlohaCare Medicaid |
$225.50
|
| Rate for Payer: AlohaCare Medicare |
$405.90
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Devoted Health Medicare |
$446.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Humana Medicare |
$405.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$230.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.90
|
| Rate for Payer: MDX Hawaii PPO |
$437.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.90
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG SMALL BOWEL/GASTRO
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
H3200772
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$976.65 |
| Max. Negotiated Rate |
$1,114.53 |
| Rate for Payer: Cash Price |
$746.85
|
| Rate for Payer: Health Management Network Commercial |
$976.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,034.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,114.53
|
|
|
HCHG SMALL BOWEL/GASTRO
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
HCPCS 74250
|
| Hospital Charge Code |
H3200772
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$1,137.51 |
| Rate for Payer: AlohaCare Medicaid |
$574.50
|
| Rate for Payer: AlohaCare Medicare |
$1,034.10
|
| Rate for Payer: Cash Price |
$746.85
|
| Rate for Payer: Cash Price |
$746.85
|
| Rate for Payer: Devoted Health Medicare |
$1,137.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,034.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$976.65
|
| Rate for Payer: Humana Medicare |
$1,034.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,034.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$585.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,034.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,114.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,034.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,034.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,034.10
|
| Rate for Payer: University Health Alliance Commercial |
$191.35
|
|
|
HCHG SMEAR COMPLEX SP STAIN
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
K3060022
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$376.55 |
| Max. Negotiated Rate |
$429.71 |
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Health Management Network Commercial |
$376.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.70
|
| Rate for Payer: MDX Hawaii PPO |
$429.71
|
|
|
HCHG SMEAR COMPLEX SP STAIN
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
K3060022
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$438.57 |
| Rate for Payer: AlohaCare Medicaid |
$221.50
|
| Rate for Payer: AlohaCare Medicare |
$398.70
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Devoted Health Medicare |
$438.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$398.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.98
|
| Rate for Payer: Health Management Network Commercial |
$376.55
|
| Rate for Payer: Humana Medicare |
$398.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$398.70
|
| Rate for Payer: MDX Hawaii PPO |
$429.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$398.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$398.70
|
| Rate for Payer: University Health Alliance Commercial |
$46.45
|
|
|
HCHG SMEAR SPECIAL FOR CRYPTO
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
H3060466
|
|
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
|
|
