|
HCHG BURN WO ANESTH LG
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
H4500148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG BURN WO ANESTH MED
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
H4500150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$447.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$447.00
|
| Rate for Payer: AlohaCare Medicare |
$804.60
|
| Rate for Payer: Cash Price |
$581.10
|
| Rate for Payer: Cash Price |
$581.10
|
| Rate for Payer: Devoted Health Medicare |
$885.06
|
| 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 |
$804.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$849.30
|
| Rate for Payer: Health Management Network Commercial |
$759.90
|
| Rate for Payer: Humana Medicare |
$804.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$804.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$804.60
|
| Rate for Payer: MDX Hawaii PPO |
$867.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$804.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$804.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$804.60
|
| Rate for Payer: University Health Alliance Commercial |
$651.64
|
|
|
HCHG BURN WO ANESTH MED
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
H4500150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$759.90 |
| Max. Negotiated Rate |
$867.18 |
| Rate for Payer: Cash Price |
$581.10
|
| Rate for Payer: Health Management Network Commercial |
$759.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$804.60
|
| Rate for Payer: MDX Hawaii PPO |
$867.18
|
|
|
HCHG BURN WO ANESTH SML
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
H4500152
|
|
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 SML
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
H4500152
|
|
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 BX BONE DEEP
|
Facility
|
OP
|
$3,641.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
H3610128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,820.50
|
| Rate for Payer: AlohaCare Medicare |
$3,276.90
|
| Rate for Payer: Cash Price |
$2,366.65
|
| Rate for Payer: Cash Price |
$2,366.65
|
| Rate for Payer: Cash Price |
$2,366.65
|
| Rate for Payer: Devoted Health Medicare |
$3,604.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,109.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,276.90
|
| Rate for Payer: Health Management Network Commercial |
$3,094.85
|
| Rate for Payer: Humana Medicare |
$3,276.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,276.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,276.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,531.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,276.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,276.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,276.90
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG BX BONE DEEP
|
Facility
|
IP
|
$3,641.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
H3610128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,094.85 |
| Max. Negotiated Rate |
$3,531.77 |
| Rate for Payer: Cash Price |
$2,366.65
|
| Rate for Payer: Health Management Network Commercial |
$3,094.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,276.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,531.77
|
|
|
HCHG C1 ESTERASE INHIBITOR, PROTEIN
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3021025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| 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 |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| 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 |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HCHG C1 ESTERASE INHIBITOR, PROTEIN
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3021025
|
|
Hospital Revenue Code
|
302
|
| 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 CA 125
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
H3020356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG CA 125
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
H3020356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 15-3 90
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020358
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG CA 15-3 90
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020358
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 19-9 90
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
H3020360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG CA 19-9 90
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
H3020360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 27.29 BIOMIRA 90
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 27.29 BIOMIRA 90
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG CADMIUM 90
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
H3010298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
|
|
HCHG CADMIUM 90
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
H3010298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: AlohaCare Medicaid |
$85.00
|
| Rate for Payer: AlohaCare Medicare |
$153.00
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Devoted Health Medicare |
$168.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.64
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Humana Medicare |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.00
|
| Rate for Payer: University Health Alliance Commercial |
$59.81
|
|
|
HCHG CALCITONIN 90
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
H3010304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.79 |
| 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 |
$37.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.79
|
| 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 |
$37.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.10
|
| Rate for Payer: University Health Alliance Commercial |
$69.21
|
|
|
HCHG CALCITONIN 90
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
H3010304
|
|
Hospital Revenue Code
|
301
|
| 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 CALCIUM IONIZED
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
H3010310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HCHG CALCIUM IONIZED
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
H3010310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$102.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.68
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.32
|
|
|
HCHG CALCIUM TOTAL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
H3010306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
HCHG CALCIUM TOTAL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
H3010306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$36.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Devoted Health Medicare |
$39.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.16
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$36.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.00
|
| Rate for Payer: University Health Alliance Commercial |
$13.32
|
|
