|
HCHG TRT TARSAL JOINT DISLOCATION
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
H4500962
|
|
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 TRT TARSAL JOINT DISLOCATION
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
H4500962
|
|
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 TRYPTASE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011602
|
|
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 TRYPTASE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011602
|
|
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 TSH
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: AlohaCare Medicaid |
$155.00
|
| Rate for Payer: AlohaCare Medicare |
$279.00
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Devoted Health Medicare |
$306.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Humana Medicare |
$279.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.00
|
| Rate for Payer: University Health Alliance Commercial |
$43.42
|
|
|
HCHG TSH
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$306.90 |
| Rate for Payer: AlohaCare Medicaid |
$155.00
|
| Rate for Payer: AlohaCare Medicare |
$279.00
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Devoted Health Medicare |
$306.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Humana Medicare |
$279.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$158.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.00
|
| Rate for Payer: University Health Alliance Commercial |
$43.42
|
|
|
HCHG TSH
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$300.70 |
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
|
|
HCHG TSH
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$263.50 |
| Max. Negotiated Rate |
$300.70 |
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Health Management Network Commercial |
$263.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$279.00
|
| Rate for Payer: MDX Hawaii PPO |
$300.70
|
|
|
HCHG T-SPINE 2 VIEWS
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200842
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG T-SPINE 2 VIEWS
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200842
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.34 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$70.43
|
|
|
HCHG T-SPINE 2 VIEWS PORT
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.34 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$70.43
|
|
|
HCHG T-SPINE 2 VIEWS PORT
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG T-SPINE 3 VIEWS
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
H3200788
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$78.96
|
|
|
HCHG T-SPINE 3 VIEWS
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
H3200788
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG TX SPLIT WOUND SIMP CLOSURE
|
Facility
|
IP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
H4500836
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,708.95 |
| Max. Negotiated Rate |
$3,091.39 |
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
|
|
HCHG TX SPLIT WOUND SIMP CLOSURE
|
Facility
|
OP
|
$3,187.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
H4500836
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,155.13 |
| Rate for Payer: AlohaCare Medicaid |
$1,593.50
|
| Rate for Payer: AlohaCare Medicare |
$2,868.30
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Cash Price |
$2,071.55
|
| Rate for Payer: Devoted Health Medicare |
$3,155.13
|
| 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 |
$2,868.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,027.65
|
| Rate for Payer: Health Management Network Commercial |
$2,708.95
|
| Rate for Payer: Humana Medicare |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,868.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,868.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,091.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,868.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,868.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,868.30
|
| Rate for Payer: University Health Alliance Commercial |
$2,323.00
|
|
|
HCHG TX WND DEHISCENCE W PACKING
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
H4500838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,162.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,092.00
|
| Rate for Payer: AlohaCare Medicare |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Devoted Health Medicare |
$2,162.16
|
| 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 |
$1,965.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,074.80
|
| Rate for Payer: Health Management Network Commercial |
$1,856.40
|
| Rate for Payer: Humana Medicare |
$1,965.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,965.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,965.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,118.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,965.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,965.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,965.60
|
| Rate for Payer: University Health Alliance Commercial |
$1,591.92
|
|
|
HCHG TX WND DEHISCENCE W PACKING
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
H4500838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,856.40 |
| Max. Negotiated Rate |
$2,118.48 |
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Health Management Network Commercial |
$1,856.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,965.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,118.48
|
|
|
HCHG TYROSINE SO
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 84510
|
| Hospital Charge Code |
K3010064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$291.06 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$264.60
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Devoted Health Medicare |
$291.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.63
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$264.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.60
|
| Rate for Payer: University Health Alliance Commercial |
$26.88
|
|
|
HCHG TYROSINE SO
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 84510
|
| Hospital Charge Code |
K3010064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HCHG UA, AUTOMATED W/MICRO, REFLEX TO CULTURE
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
H3070116
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
HCHG UA, AUTOMATED W/MICRO, REFLEX TO CULTURE
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
H3070116
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$59.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.00
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HCHG UA, AUTOMATED, W/ MICROSCOPY
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
H3070110
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
HCHG UA, AUTOMATED, W/ MICROSCOPY
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
H3070110
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$59.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.00
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HCHG UA (DIPSTICK), NON-AUTOMATED, W/O MICROSCOPY
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
H3070120
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
