|
HCHG BLADDER IRRIG SIMPL LAV/INSTIL
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
H4500144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,235.05 |
| Max. Negotiated Rate |
$1,409.41 |
| Rate for Payer: Cash Price |
$944.45
|
| Rate for Payer: Health Management Network Commercial |
$1,235.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,307.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,409.41
|
|
|
HCHG BLADDER IRRIG SIMPL LAV/INSTIL
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
H4500144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$726.50
|
| Rate for Payer: AlohaCare Medicare |
$1,307.70
|
| Rate for Payer: Cash Price |
$944.45
|
| Rate for Payer: Cash Price |
$944.45
|
| Rate for Payer: Devoted Health Medicare |
$1,438.47
|
| 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 |
$1,307.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,380.35
|
| Rate for Payer: Health Management Network Commercial |
$1,235.05
|
| Rate for Payer: Humana Medicare |
$1,307.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,307.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,307.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,409.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,307.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,307.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,307.70
|
| Rate for Payer: University Health Alliance Commercial |
$1,059.09
|
|
|
HCHG BLASTOMYCES ANTIBODY - 90
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86612
|
| Hospital Charge Code |
H3021101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.82 |
| 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 |
$10.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.90
|
| 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 |
$10.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.36
|
|
|
HCHG BLASTOMYCES ANTIBODY - 90
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86612
|
| Hospital Charge Code |
H3021101
|
|
Hospital Revenue Code
|
302
|
| 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 BLEPHAROTOMY DRAIN ABSC EYELID
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
H4501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,718.64 |
| Rate for Payer: AlohaCare Medicaid |
$868.00
|
| Rate for Payer: AlohaCare Medicare |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Devoted Health Medicare |
$1,718.64
|
| 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 |
$1,562.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,649.20
|
| Rate for Payer: Health Management Network Commercial |
$1,475.60
|
| Rate for Payer: Humana Medicare |
$1,562.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,562.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,562.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,683.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,562.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,562.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,562.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,265.37
|
|
|
HCHG BLEPHAROTOMY DRAIN ABSC EYELID
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
H4501097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,475.60 |
| Max. Negotiated Rate |
$1,683.92 |
| Rate for Payer: Cash Price |
$1,128.40
|
| Rate for Payer: Health Management Network Commercial |
$1,475.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,562.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,683.92
|
|
|
HCHG BLOOD COUNT AUTO DIFF
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 85004
|
| Hospital Charge Code |
K3050001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$116.82 |
| Rate for Payer: AlohaCare Medicaid |
$59.00
|
| Rate for Payer: AlohaCare Medicare |
$106.20
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Devoted Health Medicare |
$116.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Humana Medicare |
$106.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.20
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.20
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HCHG BLOOD COUNT AUTO DIFF
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 85004
|
| Hospital Charge Code |
K3050001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.20
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
|
|
HCHG BLOOD GASES, CAPILLARY
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3011613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HCHG BLOOD GASES, CAPILLARY
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3011613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: AlohaCare Medicaid |
$90.00
|
| Rate for Payer: AlohaCare Medicare |
$162.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$178.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$162.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HCHG BLOOD TYPING ABO
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
H3020314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
|
|
HCHG BLOOD TYPING ABO
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
H3020314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: AlohaCare Medicaid |
$102.00
|
| Rate for Payer: AlohaCare Medicare |
$183.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Devoted Health Medicare |
$201.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Humana Medicare |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.60
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.60
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HCHG BLOOD TYPING RH
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: AlohaCare Medicaid |
$31.00
|
| Rate for Payer: AlohaCare Medicare |
$55.80
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Devoted Health Medicare |
$61.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Humana Medicare |
$55.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.80
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HCHG BLOOD TYPING RH
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
|
|
HCHG BONE AGE
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
H3200218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.85 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Health Management Network Commercial |
$493.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.90
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
|
|
HCHG BONE AGE
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
H3200218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$575.19 |
| Rate for Payer: AlohaCare Medicaid |
$290.50
|
| Rate for Payer: AlohaCare Medicare |
$522.90
|
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Devoted Health Medicare |
$575.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$522.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$493.85
|
| Rate for Payer: Humana Medicare |
$522.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$296.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$522.90
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$522.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$522.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$522.90
|
| Rate for Payer: University Health Alliance Commercial |
$47.17
|
|
|
HCHG BONE LENGTH
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
H3200220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
|
HCHG BONE LENGTH
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
H3200220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$829.62 |
| Rate for Payer: AlohaCare Medicaid |
$419.00
|
| Rate for Payer: AlohaCare Medicare |
$754.20
|
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Devoted Health Medicare |
$829.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$754.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Humana Medicare |
$754.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$754.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$427.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$754.20
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$754.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$754.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$754.20
|
| Rate for Payer: University Health Alliance Commercial |
$82.49
|
|
|
HCHG BRAIN NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
H3010290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$496.98 |
| Rate for Payer: AlohaCare Medicaid |
$251.00
|
| Rate for Payer: AlohaCare Medicare |
$451.80
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Devoted Health Medicare |
$496.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$451.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Humana Medicare |
$451.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.80
|
| Rate for Payer: MDX Hawaii PPO |
$486.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$451.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$451.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$451.80
|
| Rate for Payer: University Health Alliance Commercial |
$87.75
|
|
|
HCHG BRAIN NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
H3010290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$486.94 |
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.80
|
| Rate for Payer: MDX Hawaii PPO |
$486.94
|
|
|
HCHG BRUCELLA ABORTUS
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
H3020346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HCHG BRUCELLA ABORTUS
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
H3020346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$61.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Devoted Health Medicare |
$67.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.93
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.20
|
| Rate for Payer: University Health Alliance Commercial |
$23.09
|
|
|
HCHG BURN INIT TREAT 1ST DEGREE
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
H4500146
|
|
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 BURN INIT TREAT 1ST DEGREE
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
H4500146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 |
$898.73
|
|
|
HCHG BURN WO ANESTH LG
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
H4500148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,223.54 |
| Rate for Payer: AlohaCare Medicaid |
$1,123.00
|
| Rate for Payer: AlohaCare Medicare |
$2,021.40
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$2,223.54
|
| 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 |
$2,021.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,021.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,021.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,021.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,637.11
|
|
