|
HCHG TOT B CELLS
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 86355
|
| Hospital Charge Code |
H3110268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$528.70 |
| Max. Negotiated Rate |
$603.34 |
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.80
|
| Rate for Payer: MDX Hawaii PPO |
$603.34
|
|
|
HCHG TOT B CELLS
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS 86355
|
| Hospital Charge Code |
H3110268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.89 |
| Max. Negotiated Rate |
$615.78 |
| Rate for Payer: AlohaCare Medicaid |
$311.00
|
| Rate for Payer: AlohaCare Medicare |
$559.80
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Devoted Health Medicare |
$615.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$559.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.73
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Humana Medicare |
$559.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$317.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$559.80
|
| Rate for Payer: MDX Hawaii PPO |
$603.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$559.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$559.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$559.80
|
| Rate for Payer: University Health Alliance Commercial |
$97.50
|
|
|
HCHG TOT PROTEIN URINE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
H3011307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$61.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Devoted Health Medicare |
$67.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.20
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HCHG TOT PROTEIN URINE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
H3011307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HCHG TOXIN REFLEX NAAT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
H3060683
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
|
|
HCHG TOXIN REFLEX NAAT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
H3060683
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$311.85 |
| Rate for Payer: AlohaCare Medicaid |
$157.50
|
| Rate for Payer: AlohaCare Medicare |
$283.50
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Devoted Health Medicare |
$311.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$283.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Humana Medicare |
$283.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$283.50
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$283.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$283.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG TOXOPLASMA AB IGG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
H3020790
|
|
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 TOXOPLASMA AB IGG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
H3020790
|
|
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 TOXOPLASMA IGM AB
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
H3020792
|
|
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 TOXOPLASMA IGM AB
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
H3020792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| 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 |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.41
|
| 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 |
$19.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.22
|
|
|
HCHG TPMT NUDT15 GENE ANALYSIS COMMON VARIANTS 90
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 0034U
|
| Hospital Charge Code |
H3001110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$349.63 |
| Max. Negotiated Rate |
$2,071.08 |
| Rate for Payer: AlohaCare Medicaid |
$1,046.00
|
| Rate for Payer: AlohaCare Medicare |
$1,882.80
|
| Rate for Payer: Cash Price |
$1,359.80
|
| Rate for Payer: Cash Price |
$1,359.80
|
| Rate for Payer: Devoted Health Medicare |
$2,071.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$582.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,882.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,987.40
|
| Rate for Payer: Health Management Network Commercial |
$1,778.20
|
| Rate for Payer: Humana Medicare |
$1,882.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,882.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,066.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,882.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,029.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,882.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,882.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$349.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,882.80
|
| Rate for Payer: University Health Alliance Commercial |
$1,524.86
|
|
|
HCHG TPMT NUDT15 GENE ANALYSIS COMMON VARIANTS 90
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 0034U
|
| Hospital Charge Code |
H3001110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,778.20 |
| Max. Negotiated Rate |
$2,029.24 |
| Rate for Payer: Cash Price |
$1,359.80
|
| Rate for Payer: Health Management Network Commercial |
$1,778.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,882.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,029.24
|
|
|
HCHG TRANSFERRIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
H3011238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
HCHG TRANSFERRIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
H3011238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$97.02 |
| Rate for Payer: AlohaCare Medicaid |
$49.00
|
| Rate for Payer: AlohaCare Medicare |
$88.20
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$97.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.76
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$88.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.20
|
| Rate for Payer: University Health Alliance Commercial |
$33.00
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H3910113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$1,891.89 |
| Rate for Payer: AlohaCare Medicaid |
$955.50
|
| Rate for Payer: AlohaCare Medicare |
$1,719.90
|
| Rate for Payer: Cash Price |
$1,242.15
|
| Rate for Payer: Cash Price |
$1,242.15
|
| Rate for Payer: Devoted Health Medicare |
$1,891.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$563.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,719.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,815.45
|
| Rate for Payer: Health Management Network Commercial |
$1,624.35
|
| Rate for Payer: Humana Medicare |
$1,719.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,719.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$974.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,719.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,853.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,719.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,719.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,719.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,392.93
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H3910113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1,624.35 |
| Max. Negotiated Rate |
$1,853.67 |
| Rate for Payer: Cash Price |
$1,242.15
|
| Rate for Payer: Health Management Network Commercial |
$1,624.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,719.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,853.67
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
IP
|
$1,911.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H4500826
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1,624.35 |
| Max. Negotiated Rate |
$1,853.67 |
| Rate for Payer: Cash Price |
$1,242.15
|
| Rate for Payer: Health Management Network Commercial |
$1,624.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,719.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,853.67
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
OP
|
$1,911.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H4500826
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$1,891.89 |
| Rate for Payer: AlohaCare Medicaid |
$955.50
|
| Rate for Payer: AlohaCare Medicare |
$1,719.90
|
| Rate for Payer: Cash Price |
$1,242.15
|
| Rate for Payer: Cash Price |
$1,242.15
|
| Rate for Payer: Devoted Health Medicare |
$1,891.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$563.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,719.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,815.45
|
| Rate for Payer: Health Management Network Commercial |
$1,624.35
|
| Rate for Payer: Humana Medicare |
$1,719.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,719.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$974.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,719.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,853.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,719.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,719.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,719.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,392.93
|
|
|
HCHG TRANSFUSION REACTION WORKUP
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
H3020794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$1,067.22 |
| Rate for Payer: AlohaCare Medicaid |
$539.00
|
| Rate for Payer: AlohaCare Medicare |
$970.20
|
| Rate for Payer: Cash Price |
$700.70
|
| Rate for Payer: Cash Price |
$700.70
|
| Rate for Payer: Devoted Health Medicare |
$1,067.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$970.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Humana Medicare |
$970.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$970.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$549.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$970.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,045.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$970.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$970.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$970.20
|
| Rate for Payer: University Health Alliance Commercial |
$93.72
|
|
|
HCHG TRANSFUSION REACTION WORKUP
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
H3020794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$916.30 |
| Max. Negotiated Rate |
$1,045.66 |
| Rate for Payer: Cash Price |
$700.70
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$970.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,045.66
|
|
|
HCHG TREAT ELBOW DISLOCATION W/ANES
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
H4501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG TREAT ELBOW DISLOCATION W/ANES
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
H4501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,352.50
|
| Rate for Payer: AlohaCare Medicare |
$4,234.50
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$4,657.95
|
| 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 |
$4,234.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,234.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,234.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,234.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27256
|
| Hospital Charge Code |
H4500950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27256
|
| Hospital Charge Code |
H4500950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG TREAT HUMERUS TUBEROSITY FRACTURE W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
H4500937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,234.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
