|
HCHG ANTI-GLIADIN AB IGG
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3010234
|
|
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 ANTI-GLIADIN AB IGG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3010234
|
|
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 ANTI GLOB TEST DIR COOMBS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
H3020234
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: AlohaCare Medicaid |
$47.00
|
| Rate for Payer: AlohaCare Medicare |
$84.60
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Devoted Health Medicare |
$93.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$84.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.60
|
| Rate for Payer: University Health Alliance Commercial |
$13.88
|
|
|
HCHG ANTI GLOB TEST DIR COOMBS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
H3020234
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
HCHG ANTI-GLOM BASEMT MEM AB 90
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3010236
|
|
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 ANTI-GLOM BASEMT MEM AB 90
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3010236
|
|
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 ANTI-NUCLEAR AB
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: AlohaCare Medicaid |
$112.00
|
| Rate for Payer: AlohaCare Medicare |
$201.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Devoted Health Medicare |
$221.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Humana Medicare |
$201.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$201.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HCHG ANTI-NUCLEAR AB
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$217.28 |
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
|
|
HCHG ANTISTREP O TITER
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
H3020278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HCHG ANTISTREP O TITER
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
H3020278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$98.10
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Devoted Health Medicare |
$107.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$98.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.10
|
| Rate for Payer: University Health Alliance Commercial |
$18.87
|
|
|
HCHG ANTI-THROMBIN III
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
H3050102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HCHG ANTI-THROMBIN III
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
H3050102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$81.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Devoted Health Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.85
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$81.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.00
|
| Rate for Payer: University Health Alliance Commercial |
$30.62
|
|
|
HCHG ANTI-THYROGLOBULIN
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
H3020282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HCHG ANTI-THYROGLOBULIN
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
H3020282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.91
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$108.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
HCHG ANTI-TPO MICROSOMAL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$99.90
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$109.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.55
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$99.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.90
|
| Rate for Payer: University Health Alliance Commercial |
$37.61
|
|
|
HCHG ANTI-TPO MICROSOMAL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG AP PELVIS 1-2 VIEWS
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
H3200168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$530.64 |
| Rate for Payer: AlohaCare Medicaid |
$268.00
|
| Rate for Payer: AlohaCare Medicare |
$482.40
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Devoted Health Medicare |
$530.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$482.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Humana Medicare |
$482.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$482.40
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$482.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$482.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$482.40
|
| Rate for Payer: University Health Alliance Commercial |
$55.37
|
|
|
HCHG AP PELVIS 1-2 VIEWS
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
H3200168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
|
|
HCHG APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
H4500964
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$459.00 |
| Max. Negotiated Rate |
$523.80 |
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.00
|
| Rate for Payer: MDX Hawaii PPO |
$523.80
|
|
|
HCHG APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
H4500964
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$270.00
|
| Rate for Payer: AlohaCare Medicare |
$486.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Devoted Health Medicare |
$534.60
|
| 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 |
$486.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$513.00
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Humana Medicare |
$486.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$486.00
|
| Rate for Payer: MDX Hawaii PPO |
$523.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$486.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$486.00
|
| Rate for Payer: University Health Alliance Commercial |
$393.61
|
|
|
HCHG APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
H4501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$785.50
|
| Rate for Payer: AlohaCare Medicare |
$1,413.90
|
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Devoted Health Medicare |
$1,555.29
|
| 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 |
$1,413.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,492.45
|
| Rate for Payer: Health Management Network Commercial |
$1,335.35
|
| Rate for Payer: Humana Medicare |
$1,413.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,413.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,523.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,413.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,413.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,413.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,145.10
|
|
|
HCHG APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
H4501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,335.35 |
| Max. Negotiated Rate |
$1,523.87 |
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Health Management Network Commercial |
$1,335.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,523.87
|
|
|
HCHG APPLIC SHORT ARM CAST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
H4500124
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$548.00
|
| Rate for Payer: AlohaCare Medicare |
$986.40
|
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Devoted Health Medicare |
$1,085.04
|
| 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 |
$986.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,041.20
|
| Rate for Payer: Health Management Network Commercial |
$931.60
|
| Rate for Payer: Humana Medicare |
$986.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$986.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,063.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$986.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$986.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$986.40
|
| Rate for Payer: University Health Alliance Commercial |
$798.87
|
|
|
HCHG APPLIC SHORT ARM CAST
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
H4500124
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$931.60 |
| Max. Negotiated Rate |
$1,063.12 |
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Health Management Network Commercial |
$931.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,063.12
|
|
|
HCHG APPLIC SHORT LEG CAST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
H4500126
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$548.00
|
| Rate for Payer: AlohaCare Medicare |
$986.40
|
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Cash Price |
$712.40
|
| Rate for Payer: Devoted Health Medicare |
$1,085.04
|
| 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 |
$986.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,041.20
|
| Rate for Payer: Health Management Network Commercial |
$931.60
|
| Rate for Payer: Humana Medicare |
$986.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$986.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,063.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$986.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$986.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$986.40
|
| Rate for Payer: University Health Alliance Commercial |
$798.87
|
|
