|
HCHG ABSOLUTE CD4
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 86361
|
| Hospital Charge Code |
H3110118
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: MDX Hawaii PPO |
$183.33
|
|
|
HCHG ABSOLUTE CD4
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 86361
|
| Hospital Charge Code |
H3110118
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$187.11 |
| Rate for Payer: AlohaCare Medicaid |
$94.50
|
| Rate for Payer: AlohaCare Medicare |
$170.10
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Devoted Health Medicare |
$187.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.78
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Humana Medicare |
$170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.10
|
| Rate for Payer: MDX Hawaii PPO |
$183.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.10
|
| Rate for Payer: University Health Alliance Commercial |
$46.77
|
|
|
HCHG ACCOM PRIVATE ACUTE
|
Facility
|
IP
|
$3,500.00
|
|
| Hospital Charge Code |
K0000000
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$2,975.00 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,140.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,140.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,975.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,150.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,395.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SEMI ACUTE
|
Facility
|
IP
|
$3,400.00
|
|
| Hospital Charge Code |
K0000003
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,890.00 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$2,210.00
|
| Rate for Payer: Cash Price |
$2,210.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,140.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,140.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,890.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,060.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,298.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SWING PRIV ICF
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
K0000016
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,955.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,070.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,231.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SWING PRIV SNF
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
K0000017
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$2,125.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,250.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,425.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SWING SEMI ICF
|
Facility
|
IP
|
$2,200.00
|
|
| Hospital Charge Code |
K0000004
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$1,430.00
|
| Rate for Payer: Cash Price |
$1,430.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,870.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,980.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,134.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SWING SEMI SNF
|
Facility
|
IP
|
$2,400.00
|
|
| Hospital Charge Code |
K0000005
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,560.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$2,040.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,160.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,328.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SWING WARD ICF
|
Facility
|
IP
|
$2,100.00
|
|
| Hospital Charge Code |
K0000009
|
|
Hospital Revenue Code
|
130
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$1,365.00
|
| Rate for Payer: Cash Price |
$1,365.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,785.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,890.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,037.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM SWING WARD SNF
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
K0000010
|
|
Hospital Revenue Code
|
130
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Cash Price |
$1,495.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,955.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,070.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,231.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACCOM WARD ACUTE
|
Facility
|
IP
|
$3,300.00
|
|
| Hospital Charge Code |
K0000015
|
|
Hospital Revenue Code
|
130
|
| Min. Negotiated Rate |
$2,805.00 |
| Max. Negotiated Rate |
$10,998.90 |
| Rate for Payer: AlohaCare Medicaid |
$4,140.84
|
| Rate for Payer: AlohaCare Medicare |
$9,999.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Cash Price |
$2,145.00
|
| Rate for Payer: Devoted Health Medicare |
$10,998.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4,140.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9,999.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4,140.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,805.00
|
| Rate for Payer: Humana Medicare |
$9,999.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,970.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,999.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,201.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,140.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,999.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,140.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,999.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HCHG ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
H3011724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
HCHG ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
H3011724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$136.62 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicare |
$124.20
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$136.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$124.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.20
|
| Rate for Payer: University Health Alliance Commercial |
$100.59
|
|
|
HCHG ACETAMINOPHEN TYLENOL
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
|
HCHG ACETAMINOPHEN TYLENOL
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$692.01 |
| Rate for Payer: AlohaCare Medicaid |
$349.50
|
| Rate for Payer: AlohaCare Medicare |
$629.10
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$692.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$629.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Humana Medicare |
$629.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$629.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$629.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$629.10
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HCHG ACETYLCHOLINE RECEP AB MOD
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3000120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HCHG ACETYLCHOLINE RECEP AB MOD
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3000120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$135.63 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Devoted Health Medicare |
$135.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.40
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.30
|
| Rate for Payer: University Health Alliance Commercial |
$34.93
|
|
|
HCHG ACETYLCHOLINE RECEPTOR AB 90
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3010120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HCHG ACETYLCHOLINE RECEPTOR AB 90
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3010120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$135.63 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Devoted Health Medicare |
$135.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.40
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.30
|
| Rate for Payer: University Health Alliance Commercial |
$34.93
|
|
|
HCHG ACID FAST BACILLI ID BY MALDI
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
H3060712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$212.85 |
| Rate for Payer: AlohaCare Medicaid |
$107.50
|
| Rate for Payer: AlohaCare Medicare |
$193.50
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Devoted Health Medicare |
$212.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.61
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Humana Medicare |
$193.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.50
|
| Rate for Payer: MDX Hawaii PPO |
$208.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$193.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.50
|
| Rate for Payer: University Health Alliance Commercial |
$28.29
|
|
|
HCHG ACID FAST BACILLI ID BY MALDI
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
H3060712
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$208.55 |
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$193.50
|
| Rate for Payer: MDX Hawaii PPO |
$208.55
|
|
|
HCHG ACTH LEVEL RIA 90
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
H3010130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$752.40 |
| Rate for Payer: AlohaCare Medicaid |
$380.00
|
| Rate for Payer: AlohaCare Medicare |
$684.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Devoted Health Medicare |
$752.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$684.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.62
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Humana Medicare |
$684.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$387.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$684.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$684.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$684.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$684.00
|
| Rate for Payer: University Health Alliance Commercial |
$99.84
|
|
|
HCHG ACTH LEVEL RIA 90
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
H3010130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$737.20 |
| Rate for Payer: Cash Price |
$494.00
|
| Rate for Payer: Health Management Network Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$684.00
|
| Rate for Payer: MDX Hawaii PPO |
$737.20
|
|
|
HCHG ACTIN (SMOOTH MUSCLE) AB
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
H3021041
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| 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 |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| 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 |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$67.06
|
|
|
HCHG ACTIN (SMOOTH MUSCLE) AB
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
H3021041
|
|
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
|
|
