|
HCHG SMEAR SPECIAL FOR CRYPTO
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
H3060466
|
|
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 SODIUM SERUM/PLASMA/WHOLE BLOOD
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
H3011158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG SODIUM SERUM/PLASMA/WHOLE BLOOD
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
H3011158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$33.30
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$36.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.30
|
| Rate for Payer: University Health Alliance Commercial |
$12.43
|
|
|
HCHG SODIUM-URINE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
H3011168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Devoted Health Medicare |
$71.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.06
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$64.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.80
|
| Rate for Payer: University Health Alliance Commercial |
$12.56
|
|
|
HCHG SODIUM-URINE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
H3011168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
|
|
HCHG SOLUBLE LIVER AG IGG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$125.13 |
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
|
|
HCHG SOLUBLE LIVER AG IGG
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: AlohaCare Medicaid |
$64.50
|
| Rate for Payer: AlohaCare Medicare |
$116.10
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Devoted Health Medicare |
$127.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Humana Medicare |
$116.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG SP CLINICAL SWALLOW EVAL
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
H4440102
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
|
|
HCHG SP CLINICAL SWALLOW EVAL
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
H4440102
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$88.36 |
| Max. Negotiated Rate |
$682.11 |
| Rate for Payer: AlohaCare Medicaid |
$344.50
|
| Rate for Payer: AlohaCare Medicare |
$620.10
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Devoted Health Medicare |
$682.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$620.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$654.55
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Humana Medicare |
$620.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$351.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$620.10
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$620.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$620.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$620.10
|
| Rate for Payer: University Health Alliance Commercial |
$502.21
|
|
|
HCHG SPCL STN GROUP I
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
H3120308
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$320.76 |
| Rate for Payer: AlohaCare Medicaid |
$162.00
|
| Rate for Payer: AlohaCare Medicare |
$291.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Devoted Health Medicare |
$320.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$291.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network Commercial |
$275.40
|
| Rate for Payer: Humana Medicare |
$291.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$291.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.60
|
| Rate for Payer: MDX Hawaii PPO |
$314.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$291.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.60
|
| Rate for Payer: University Health Alliance Commercial |
$187.61
|
|
|
HCHG SPCL STN GROUP I
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
H3120308
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$314.28 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Health Management Network Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$291.60
|
| Rate for Payer: MDX Hawaii PPO |
$314.28
|
|
|
HCHG SPCL STN GROUP II ALL OTHER
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
H3120309
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
HCHG SPCL STN GROUP II ALL OTHER
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
H3120309
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$387.00
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Cash Price |
$279.50
|
| Rate for Payer: Devoted Health Medicare |
$425.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$387.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.93
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$387.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$387.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$387.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$387.00
|
| Rate for Payer: University Health Alliance Commercial |
$144.02
|
|
|
HCHG SPCL STN STOOL
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
H3120276
|
|
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 SPCL STN STOOL
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
H3120276
|
|
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 SP COGNITIVE PERF TESTING PER HR
|
Facility
|
IP
|
$576.00
|
|
|
Service Code
|
HCPCS 96125
|
| Hospital Charge Code |
H4400164
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$558.72 |
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Health Management Network Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$518.40
|
| Rate for Payer: MDX Hawaii PPO |
$558.72
|
|
|
HCHG SP COGNITIVE PERF TESTING PER HR
|
Facility
|
OP
|
$576.00
|
|
|
Service Code
|
HCPCS 96125
|
| Hospital Charge Code |
H4400164
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$570.24 |
| Rate for Payer: AlohaCare Medicaid |
$288.00
|
| Rate for Payer: AlohaCare Medicare |
$518.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Devoted Health Medicare |
$570.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$518.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$547.20
|
| Rate for Payer: Health Management Network Commercial |
$489.60
|
| Rate for Payer: Humana Medicare |
$518.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$518.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$293.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$518.40
|
| Rate for Payer: MDX Hawaii PPO |
$558.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$518.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$518.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$518.40
|
| Rate for Payer: University Health Alliance Commercial |
$419.85
|
|
|
HCHG SPECIFIC GRAVITY, URINE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
H3011453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| 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 |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.80
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HCHG SPECIFIC GRAVITY, URINE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
H3011453
|
|
Hospital Revenue Code
|
301
|
| 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 SPECIMEN INFECT AGNT CONCNTJ
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
H3060140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
HCHG SPECIMEN INFECT AGNT CONCNTJ
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
H3060140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$149.40
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$164.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.68
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$149.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.40
|
| Rate for Payer: University Health Alliance Commercial |
$17.26
|
|
|
HCHG SPEECH PRODUCTION W LANG COMPREHEN EVAL
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 92523
|
| Hospital Charge Code |
H4400345
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$1,007.25 |
| Max. Negotiated Rate |
$1,149.45 |
| Rate for Payer: Cash Price |
$770.25
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,066.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,149.45
|
|
|
HCHG SPEECH PRODUCTION W LANG COMPREHEN EVAL
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 92523
|
| Hospital Charge Code |
H4400345
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$240.61 |
| Max. Negotiated Rate |
$1,173.15 |
| Rate for Payer: AlohaCare Medicaid |
$592.50
|
| Rate for Payer: AlohaCare Medicare |
$1,066.50
|
| Rate for Payer: Cash Price |
$770.25
|
| Rate for Payer: Cash Price |
$770.25
|
| Rate for Payer: Devoted Health Medicare |
$1,173.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,066.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,125.75
|
| Rate for Payer: Health Management Network Commercial |
$1,007.25
|
| Rate for Payer: Humana Medicare |
$1,066.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,066.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$604.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,066.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,149.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,066.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,066.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,066.50
|
| Rate for Payer: University Health Alliance Commercial |
$863.75
|
|
|
HCHG SP FEES W CINE & VIDEO
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS 92612
|
| Hospital Charge Code |
H4440137
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$827.90 |
| Max. Negotiated Rate |
$944.78 |
| Rate for Payer: Cash Price |
$633.10
|
| Rate for Payer: Health Management Network Commercial |
$827.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$876.60
|
| Rate for Payer: MDX Hawaii PPO |
$944.78
|
|
|
HCHG SP FEES W CINE & VIDEO
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS 92612
|
| Hospital Charge Code |
H4440137
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$49.97 |
| Max. Negotiated Rate |
$964.26 |
| Rate for Payer: AlohaCare Medicaid |
$487.00
|
| Rate for Payer: AlohaCare Medicare |
$876.60
|
| Rate for Payer: Cash Price |
$633.10
|
| Rate for Payer: Cash Price |
$633.10
|
| Rate for Payer: Devoted Health Medicare |
$964.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$876.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$925.30
|
| Rate for Payer: Health Management Network Commercial |
$827.90
|
| Rate for Payer: Humana Medicare |
$876.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$876.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$496.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$876.60
|
| Rate for Payer: MDX Hawaii PPO |
$944.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$876.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$876.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$876.60
|
| Rate for Payer: University Health Alliance Commercial |
$709.95
|
|
