|
HCHG TREAT HUMERUS TUBEROSITY FRACTURE W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
H4500937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,657.95 |
| 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 |
$3,429.47
|
|
|
HCHG TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
H4500936
|
|
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 SHOULDER BLADE FX
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
H4500936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,657.95 |
| 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 Medicare |
$4,234.50
|
| Rate for Payer: University Health Alliance Commercial |
$3,429.47
|
|
|
HCHG TREPONEMA PALLIDUM AB CSF
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
H3020796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$99.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$35.09
|
|
|
HCHG TREPONEMA PALLIDUM AB CSF
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
H3020796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HCHG TRICHOMONAS VAG, AMP PROBE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
H3060732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$236.68 |
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.60
|
| Rate for Payer: MDX Hawaii PPO |
$236.68
|
|
|
HCHG TRICHOMONAS VAG, AMP PROBE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
H3060732
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$241.56 |
| Rate for Payer: AlohaCare Medicaid |
$122.00
|
| Rate for Payer: AlohaCare Medicare |
$219.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$241.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$219.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Humana Medicare |
$219.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$219.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.60
|
| Rate for Payer: MDX Hawaii PPO |
$236.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$219.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$219.60
|
| Rate for Payer: University Health Alliance Commercial |
$88.56
|
|
|
HCHG TRICHOMONAS VAG, DIRECT PROBE
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 87660
|
| Hospital Charge Code |
H3060678
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$270.27 |
| Rate for Payer: AlohaCare Medicaid |
$136.50
|
| Rate for Payer: AlohaCare Medicare |
$245.70
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Devoted Health Medicare |
$270.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Humana Medicare |
$245.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.70
|
| Rate for Payer: University Health Alliance Commercial |
$51.84
|
|
|
HCHG TRICHOMONAS VAG, DIRECT PROBE
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 87660
|
| Hospital Charge Code |
H3060678
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
HCHG TRIGLYCERIDES
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
H3011242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
HCHG TRIGLYCERIDES
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
H3011242
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$43.56 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$39.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Devoted Health Medicare |
$43.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.74
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$39.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.60
|
| Rate for Payer: University Health Alliance Commercial |
$14.87
|
|
|
HCHG TRIGLYCERIDES BODY FLUID
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
H3011246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
HCHG TRIGLYCERIDES BODY FLUID
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
H3011246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$43.56 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$39.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Devoted Health Medicare |
$43.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.74
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$39.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.60
|
| Rate for Payer: University Health Alliance Commercial |
$14.87
|
|
|
HCHG TRIM NONDYSTROPHIC NAILS, ANY #
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
H4501126
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$385.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$423.72
|
| 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 |
$385.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$385.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.20
|
| Rate for Payer: University Health Alliance Commercial |
$311.97
|
|
|
HCHG TRIM NONDYSTROPHIC NAILS, ANY #
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
H4501126
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
HCHG TROPONIN, I HIGH SENSITIVITY
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$78.30
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Devoted Health Medicare |
$86.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$78.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.30
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HCHG TROPONIN, I HIGH SENSITIVITY
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HCHG TROPONIN, I HIGH SENSITIVITY - 90
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
HCHG TROPONIN, I HIGH SENSITIVITY - 90
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$148.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$163.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$148.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.50
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HCHG TROPONIN I POC
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$148.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$163.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$148.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.50
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HCHG TROPONIN I POC
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011349
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
HCHG TROPONIN T
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
HCHG TROPONIN T
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$163.35 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$148.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$163.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$148.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.50
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HCHG TRT DISTAL TIBIA FRACTURE W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
H4500957
|
|
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 TRT DISTAL TIBIA FRACTURE W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
H4500957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,657.95 |
| 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 |
$3,429.47
|
|
