|
HCHG ARTHROCENTESIS SMALL JNT
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
H4500134
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$779.50
|
| Rate for Payer: AlohaCare Medicare |
$1,403.10
|
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Devoted Health Medicare |
$1,543.41
|
| 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 |
$1,403.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,481.05
|
| Rate for Payer: Health Management Network Commercial |
$1,325.15
|
| Rate for Payer: Humana Medicare |
$1,403.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,403.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,403.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,512.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,403.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,403.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,403.10
|
| Rate for Payer: University Health Alliance Commercial |
$1,136.36
|
|
|
HCHG ARTHROCENTESIS SMALL JNT
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
H4500134
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,325.15 |
| Max. Negotiated Rate |
$1,512.23 |
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Health Management Network Commercial |
$1,325.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,403.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,512.23
|
|
|
HCHG ASP BLADDER SUPRAPUB CATH INS
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
H4500138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,170.55 |
| Max. Negotiated Rate |
$5,900.51 |
| Rate for Payer: Cash Price |
$3,953.95
|
| Rate for Payer: Health Management Network Commercial |
$5,170.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,474.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,900.51
|
|
|
HCHG ASP BLADDER SUPRAPUB CATH INS
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
H4500138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,022.17 |
| Rate for Payer: AlohaCare Medicaid |
$3,041.50
|
| Rate for Payer: AlohaCare Medicare |
$5,474.70
|
| Rate for Payer: Cash Price |
$3,953.95
|
| Rate for Payer: Cash Price |
$3,953.95
|
| Rate for Payer: Devoted Health Medicare |
$6,022.17
|
| 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 |
$5,474.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,778.85
|
| Rate for Payer: Health Management Network Commercial |
$5,170.55
|
| Rate for Payer: Humana Medicare |
$5,474.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,474.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,474.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,900.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,474.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,474.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,474.70
|
| Rate for Payer: University Health Alliance Commercial |
$4,433.90
|
|
|
HCHG ASPERGILLUS AB 90
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
H3020286
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
HCHG ASPERGILLUS AB 90
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
H3020286
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$112.86 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$102.60
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$112.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$102.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.60
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HCHG ASPERGILLUS AG EIA 90
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
H3060711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG ASPERGILLUS AG EIA 90
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
H3060711
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG ASPIRATE PLEURA W/ IMAGING
|
Facility
|
IP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
H4501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,731.90 |
| Max. Negotiated Rate |
$3,117.58 |
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Health Management Network Commercial |
$2,731.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,892.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,117.58
|
|
|
HCHG ASPIRATE PLEURA W/ IMAGING
|
Facility
|
OP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
H4501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,607.00
|
| Rate for Payer: AlohaCare Medicare |
$2,892.60
|
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Devoted Health Medicare |
$3,181.86
|
| 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 |
$2,892.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,053.30
|
| Rate for Payer: Health Management Network Commercial |
$2,731.90
|
| Rate for Payer: Humana Medicare |
$2,892.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,892.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,892.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,117.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,892.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,892.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,892.60
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG ASPIRATE PLEURA W/O IMAGING
|
Facility
|
OP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
H4501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,607.00
|
| Rate for Payer: AlohaCare Medicare |
$2,892.60
|
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Devoted Health Medicare |
$3,181.86
|
| 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 |
$2,892.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,053.30
|
| Rate for Payer: Health Management Network Commercial |
$2,731.90
|
| Rate for Payer: Humana Medicare |
$2,892.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,892.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,892.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,117.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,892.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,892.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,892.60
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG ASPIRATE PLEURA W/O IMAGING
|
Facility
|
IP
|
$3,214.00
|
|
|
Service Code
|
HCPCS 32554
|
| Hospital Charge Code |
H4501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,731.90 |
| Max. Negotiated Rate |
$3,117.58 |
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Health Management Network Commercial |
$2,731.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,892.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,117.58
|
|
|
HCHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH 90
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3011706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$63.90
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$70.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.30
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$63.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
HCHG ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH 90
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3011706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
H3001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HCHG ASSAY SPEC XCP UR&BREATH IA
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 82077
|
| Hospital Charge Code |
H3001130
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$117.81 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$107.10
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Devoted Health Medicare |
$117.81
|
| 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 |
$107.10
|
| 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 |
$101.15
|
| Rate for Payer: Humana Medicare |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.10
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
|
|
HCHG ASSESS & TREAT PDP INIT EVAL
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
H4600183
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$822.80 |
| Max. Negotiated Rate |
$938.96 |
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.20
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
|
|
HCHG ASSESS & TREAT PDP INIT EVAL
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
H4600183
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$958.32 |
| Rate for Payer: AlohaCare Medicaid |
$484.00
|
| Rate for Payer: AlohaCare Medicare |
$871.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Devoted Health Medicare |
$958.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$164.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$871.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$919.60
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Humana Medicare |
$871.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$493.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$871.20
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$871.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$871.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$871.20
|
| Rate for Payer: University Health Alliance Commercial |
$705.58
|
|
|
HCHG ATYPICAL P-ANCA TITER
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
H3021045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
|
HCHG ATYPICAL P-ANCA TITER
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
H3021045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$79.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$87.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$64.14
|
|
|
HCHG AVULSION NAIL PLATE SNGL
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
H4500142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$616.50
|
| Rate for Payer: AlohaCare Medicare |
$1,109.70
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$1,220.67
|
| 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 |
$1,109.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,171.35
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$1,109.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,109.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,109.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,109.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,109.70
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG AVULSION NAIL PLATE SNGL
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
H4500142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG BARIUM ENEMA DOUBLE CONTRAST
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
H3200138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$1,183.05 |
| Rate for Payer: AlohaCare Medicaid |
$597.50
|
| Rate for Payer: AlohaCare Medicare |
$1,075.50
|
| Rate for Payer: Cash Price |
$776.75
|
| Rate for Payer: Cash Price |
$776.75
|
| Rate for Payer: Devoted Health Medicare |
$1,183.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,075.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$1,015.75
|
| Rate for Payer: Humana Medicare |
$1,075.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,075.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$609.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,075.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,159.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,075.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,075.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,075.50
|
| Rate for Payer: University Health Alliance Commercial |
$370.48
|
|
|
HCHG BARIUM ENEMA DOUBLE CONTRAST
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
H3200138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,015.75 |
| Max. Negotiated Rate |
$1,159.15 |
| Rate for Payer: Cash Price |
$776.75
|
| Rate for Payer: Health Management Network Commercial |
$1,015.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,075.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,159.15
|
|
|
HCHG BASIC METABOLIC PROFILE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
H3010262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$134.10
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$147.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.46
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$134.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.10
|
| Rate for Payer: University Health Alliance Commercial |
$21.89
|
|
