|
HCHG AB COXIELLA BRUNETII EA
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG AB COXIELLA BRUNETTI EA
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
HCHG AB COXIELLA BRUNETTI EA
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$700.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$637.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$700.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$637.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$637.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.20
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
HCHG ABDOMEN 2 VIEWS PORT
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG ABDOMEN 2 VIEWS PORT
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$700.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$637.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$700.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$637.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$637.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.20
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
HCHG ABDOMEN AP 1 VIEW
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$499.95 |
| Rate for Payer: AlohaCare Medicaid |
$252.50
|
| Rate for Payer: AlohaCare Medicare |
$454.50
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Devoted Health Medicare |
$499.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Humana Medicare |
$454.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$454.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG ABDOMEN AP 1 VIEW
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
|
|
HCHG ABDOMEN-CROSS TABLE LAT-PORT AP 1 VW
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$499.95 |
| Rate for Payer: AlohaCare Medicaid |
$252.50
|
| Rate for Payer: AlohaCare Medicare |
$454.50
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Devoted Health Medicare |
$499.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Humana Medicare |
$454.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$454.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG ABDOMEN-CROSS TABLE LAT-PORT AP 1 VW
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
|
|
HCHG ABDOMEN DECUBITUS AP 1 VIEW
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$499.95 |
| Rate for Payer: AlohaCare Medicaid |
$252.50
|
| Rate for Payer: AlohaCare Medicare |
$454.50
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Devoted Health Medicare |
$499.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Humana Medicare |
$454.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$454.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG ABDOMEN DECUBITUS AP 1 VIEW
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
|
|
HCHG ABD PARACENTESIS DIAG/THERP;W/O IMG GUID
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
H4501045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG ABD PARACENTESIS DIAG/THERP;W/O IMG GUID
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
H4501045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,489.65 |
| Rate for Payer: AlohaCare Medicaid |
$2,267.50
|
| Rate for Payer: AlohaCare Medicare |
$4,081.50
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$4,489.65
|
| 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 |
$4,081.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,081.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,081.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,081.50
|
| Rate for Payer: University Health Alliance Commercial |
$3,305.56
|
|
|
HCHG ABD PARACENTESIS DX/THER W/IMG GUID
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
H4501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,489.65 |
| Rate for Payer: AlohaCare Medicaid |
$2,267.50
|
| Rate for Payer: AlohaCare Medicare |
$4,081.50
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$4,489.65
|
| 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 |
$4,081.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,081.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,081.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,081.50
|
| Rate for Payer: University Health Alliance Commercial |
$3,305.56
|
|
|
HCHG ABD PARACENTESIS DX/THER W/IMG GUID
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
H4501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG AB ID ADDL 1 PANEL
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
H3000104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$695.97 |
| Rate for Payer: AlohaCare Medicaid |
$351.50
|
| Rate for Payer: AlohaCare Medicare |
$632.70
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Devoted Health Medicare |
$695.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$632.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Humana Medicare |
$632.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$632.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$358.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$632.70
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$632.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$632.70
|
| Rate for Payer: University Health Alliance Commercial |
$512.42
|
|
|
HCHG AB ID ADDL 1 PANEL
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
H3000104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$597.55 |
| Max. Negotiated Rate |
$681.91 |
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$632.70
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
|
|
HCHG AB ID ADDL PANEL I
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
H3000106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$695.97 |
| Rate for Payer: AlohaCare Medicaid |
$351.50
|
| Rate for Payer: AlohaCare Medicare |
$632.70
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Devoted Health Medicare |
$695.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$632.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Humana Medicare |
$632.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$632.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$358.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$632.70
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$632.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$632.70
|
| Rate for Payer: University Health Alliance Commercial |
$512.42
|
|
|
HCHG AB ID ADDL PANEL I
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
H3000106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$597.55 |
| Max. Negotiated Rate |
$681.91 |
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$632.70
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
|
|
HCHG AB ID ADDL PANEL II
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
H3000110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$597.55 |
| Max. Negotiated Rate |
$681.91 |
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$632.70
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
|
|
HCHG AB ID ADDL PANEL II
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
H3000110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$695.97 |
| Rate for Payer: AlohaCare Medicaid |
$351.50
|
| Rate for Payer: AlohaCare Medicare |
$632.70
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Devoted Health Medicare |
$695.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$632.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Humana Medicare |
$632.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$632.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$358.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$632.70
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$632.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$632.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$632.70
|
| Rate for Payer: University Health Alliance Commercial |
$512.42
|
|
|
HCHG AB INFLUENZA VIR RICKETTSIA EA
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
H3020116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$140.58 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$127.80
|
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Devoted Health Medicare |
$140.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.35
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$127.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.80
|
| Rate for Payer: University Health Alliance Commercial |
$50.04
|
|
|
HCHG AB INFLUENZA VIR RICKETTSIA EA
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
H3020116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
