|
HCHG TIB/FIB, 2 VIEWS
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200538
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$550.44 |
| Rate for Payer: AlohaCare Medicaid |
$278.00
|
| Rate for Payer: AlohaCare Medicare |
$500.40
|
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Devoted Health Medicare |
$550.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$500.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$472.60
|
| Rate for Payer: Humana Medicare |
$500.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$283.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$500.40
|
| Rate for Payer: MDX Hawaii PPO |
$539.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$500.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$500.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$500.40
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
HCHG TIB/FIB PORT, 2 VIEWS
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200540
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$472.60 |
| Max. Negotiated Rate |
$539.32 |
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Health Management Network Commercial |
$472.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.40
|
| Rate for Payer: MDX Hawaii PPO |
$539.32
|
|
|
HCHG TIB/FIB PORT, 2 VIEWS
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200540
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$550.44 |
| Rate for Payer: AlohaCare Medicaid |
$278.00
|
| Rate for Payer: AlohaCare Medicare |
$500.40
|
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Cash Price |
$361.40
|
| Rate for Payer: Devoted Health Medicare |
$550.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$500.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$472.60
|
| Rate for Payer: Humana Medicare |
$500.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$283.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$500.40
|
| Rate for Payer: MDX Hawaii PPO |
$539.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$500.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$500.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$500.40
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
HCHG TISS EXAM CX/LG MULT LVL V
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
H3120284
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,041.25 |
| Max. Negotiated Rate |
$1,188.25 |
| Rate for Payer: Cash Price |
$796.25
|
| Rate for Payer: Health Management Network Commercial |
$1,041.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,102.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,188.25
|
|
|
HCHG TISS EXAM CX/LG MULT LVL V
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
H3120284
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$1,212.75 |
| Rate for Payer: AlohaCare Medicaid |
$612.50
|
| Rate for Payer: AlohaCare Medicare |
$1,102.50
|
| Rate for Payer: Cash Price |
$796.25
|
| Rate for Payer: Cash Price |
$796.25
|
| Rate for Payer: Devoted Health Medicare |
$1,212.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,102.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$1,041.25
|
| Rate for Payer: Humana Medicare |
$1,102.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,102.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$624.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,102.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,188.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,102.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,102.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,102.50
|
| Rate for Payer: University Health Alliance Commercial |
$408.52
|
|
|
HCHG TISSUE CULT
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
H3060494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$328.10 |
| Max. Negotiated Rate |
$374.42 |
| Rate for Payer: Cash Price |
$250.90
|
| Rate for Payer: Health Management Network Commercial |
$328.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$347.40
|
| Rate for Payer: MDX Hawaii PPO |
$374.42
|
|
|
HCHG TISSUE CULT
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
H3060494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$382.14 |
| Rate for Payer: AlohaCare Medicaid |
$193.00
|
| Rate for Payer: AlohaCare Medicare |
$347.40
|
| Rate for Payer: Cash Price |
$250.90
|
| Rate for Payer: Cash Price |
$250.90
|
| Rate for Payer: Devoted Health Medicare |
$382.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$328.10
|
| Rate for Payer: Humana Medicare |
$347.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$347.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$196.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$347.40
|
| Rate for Payer: MDX Hawaii PPO |
$374.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$347.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.40
|
| Rate for Payer: University Health Alliance Commercial |
$67.38
|
|
|
HCHG TISSUE CULT NEOPLAS BM/BD 90
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3100142
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$688.50 |
| Max. Negotiated Rate |
$785.70 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
|
|
HCHG TISSUE CULT NEOPLAS BM/BD 90
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3100142
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.68 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: AlohaCare Medicaid |
$405.00
|
| Rate for Payer: AlohaCare Medicare |
$729.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Devoted Health Medicare |
$801.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$179.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.75
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Humana Medicare |
$729.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$413.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$729.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.00
|
| Rate for Payer: University Health Alliance Commercial |
$326.47
|
|
|
HCHG TISSUE CULT NEOPLASM BM/BLD
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3110292
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$688.50 |
| Max. Negotiated Rate |
$785.70 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
|
|
HCHG TISSUE CULT NEOPLASM BM/BLD
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3110292
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$125.68 |
| Max. Negotiated Rate |
$801.90 |
| Rate for Payer: AlohaCare Medicaid |
$405.00
|
| Rate for Payer: AlohaCare Medicare |
$729.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Devoted Health Medicare |
$801.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$179.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.75
|
| Rate for Payer: Health Management Network Commercial |
$688.50
|
| Rate for Payer: Humana Medicare |
$729.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$413.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.00
|
| Rate for Payer: MDX Hawaii PPO |
$785.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$729.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.00
|
| Rate for Payer: University Health Alliance Commercial |
$326.47
|
|
|
HCHG TISSUE(SPECIMEN) XRAY
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,469.25 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,614.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
|
|
HCHG TISSUE(SPECIMEN) XRAY
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$2,875.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,452.50
|
| Rate for Payer: AlohaCare Medicare |
$2,614.50
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Devoted Health Medicare |
$2,875.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,614.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$558.25
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Humana Medicare |
$2,614.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,614.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,481.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,614.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,614.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,614.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,614.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.66
|
|
|
HCHG TISSUE TRANSGLUTAMINASE AB
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
H3021040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: AlohaCare Medicaid |
$114.00
|
| Rate for Payer: AlohaCare Medicare |
$205.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Devoted Health Medicare |
$225.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Humana Medicare |
$205.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.20
|
| Rate for Payer: University Health Alliance Commercial |
$166.19
|
|
|
HCHG TISSUE TRANSGLUTAMINASE AB
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
H3021040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
|
HCHG TITER, EACH ANTIBODY - 90
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
H3021064
|
|
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 TITER, EACH ANTIBODY - 90
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
H3021064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG TM JOINTS BIL
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
H3200794
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$419.05 |
| Max. Negotiated Rate |
$478.21 |
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.70
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
|
|
HCHG TM JOINTS BIL
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
H3200794
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: AlohaCare Medicaid |
$246.50
|
| Rate for Payer: AlohaCare Medicare |
$443.70
|
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Devoted Health Medicare |
$488.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$443.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Humana Medicare |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.70
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$443.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$443.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$443.70
|
| Rate for Payer: University Health Alliance Commercial |
$94.79
|
|
|
HCHG TOBRAMYCIN LEVEL RIA
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
H3011234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.13
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$41.66
|
|
|
HCHG TOBRAMYCIN LEVEL RIA
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 80200
|
| Hospital Charge Code |
H3011234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HCHG TOES MIN 2 VIEWS
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
H3200798
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$543.51 |
| Rate for Payer: AlohaCare Medicaid |
$274.50
|
| Rate for Payer: AlohaCare Medicare |
$494.10
|
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Devoted Health Medicare |
$543.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$494.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$466.65
|
| Rate for Payer: Humana Medicare |
$494.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$494.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$279.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$494.10
|
| Rate for Payer: MDX Hawaii PPO |
$532.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$494.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$494.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$494.10
|
| Rate for Payer: University Health Alliance Commercial |
$53.35
|
|
|
HCHG TOES MIN 2 VIEWS
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
H3200798
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$466.65 |
| Max. Negotiated Rate |
$532.53 |
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Health Management Network Commercial |
$466.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$494.10
|
| Rate for Payer: MDX Hawaii PPO |
$532.53
|
|
|
HCHG TOPIRAMATE
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
H3020905
|
|
Hospital Revenue Code
|
301
|
| 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 TOPIRAMATE
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
H3020905
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.92 |
| 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 |
$16.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.92
|
| 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 |
$16.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$30.82
|
|
