|
HCHG C. DIFFICILE NUCLEIC ACID AMPLIFY
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
H3060682
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$522.72 |
| Rate for Payer: AlohaCare Medicaid |
$264.00
|
| Rate for Payer: AlohaCare Medicare |
$475.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Devoted Health Medicare |
$522.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$475.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.27
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$475.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$475.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$475.20
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$475.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$475.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$475.20
|
| Rate for Payer: University Health Alliance Commercial |
$93.00
|
|
|
HCHG C. DIFFICILE NUCLEIC ACID AMPLIFY
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
H3060682
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$475.20
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
|
HCHG CEA LEVEL RIA
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
H3010336
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$126.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$138.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.96
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$126.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.00
|
| Rate for Payer: University Health Alliance Commercial |
$49.04
|
|
|
HCHG CEA LEVEL RIA
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
H3010336
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
HCHG CELL COUNT-BODY FLD
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
H3090106
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG CELL COUNT-BODY FLD
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
H3090106
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$14.24
|
|
|
HCHG CERULOPLASMIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 82390
|
| Hospital Charge Code |
H3010338
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$210.87 |
| Rate for Payer: AlohaCare Medicaid |
$106.50
|
| Rate for Payer: AlohaCare Medicare |
$191.70
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Devoted Health Medicare |
$210.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Humana Medicare |
$191.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$191.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$191.70
|
| Rate for Payer: MDX Hawaii PPO |
$206.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$191.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.70
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HCHG CERULOPLASMIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 82390
|
| Hospital Charge Code |
H3010338
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.05 |
| Max. Negotiated Rate |
$206.61 |
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$191.70
|
| Rate for Payer: MDX Hawaii PPO |
$206.61
|
|
|
HCHG CHANGE OF CYSTOSTOMY TUBE SIMPLE
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
H4500164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$705.00
|
| Rate for Payer: AlohaCare Medicare |
$1,269.00
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$1,395.90
|
| 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 |
$1,269.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,339.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Humana Medicare |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,269.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,269.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,269.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,027.75
|
|
|
HCHG CHANGE OF CYSTOSTOMY TUBE SIMPLE
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
H4500164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,198.50 |
| Max. Negotiated Rate |
$1,367.70 |
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
|
|
HCHG CHEST AP 1 VIEW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240102
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$478.55 |
| Max. Negotiated Rate |
$546.11 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
|
|
HCHG CHEST AP 1 VIEW
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240102
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$557.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.50
|
| Rate for Payer: AlohaCare Medicare |
$506.70
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Devoted Health Medicare |
$557.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Humana Medicare |
$506.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.70
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HCHG CHEST AP ONLY PORT 1 VIEW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240118
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$478.55 |
| Max. Negotiated Rate |
$546.11 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
|
|
HCHG CHEST AP ONLY PORT 1 VIEW
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240118
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$557.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.50
|
| Rate for Payer: AlohaCare Medicare |
$506.70
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Devoted Health Medicare |
$557.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Humana Medicare |
$506.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.70
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HCHG CHEST INSP/EXP 2 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240108
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$597.96 |
| Rate for Payer: AlohaCare Medicaid |
$302.00
|
| Rate for Payer: AlohaCare Medicare |
$543.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Devoted Health Medicare |
$597.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Humana Medicare |
$543.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG CHEST INSP/EXP 2 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240108
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
|
|
HCHG CHEST PA LAT 2 VIEW
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240114
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
|
|
HCHG CHEST PA LAT 2 VIEW
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240114
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$597.96 |
| Rate for Payer: AlohaCare Medicaid |
$302.00
|
| Rate for Payer: AlohaCare Medicare |
$543.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Devoted Health Medicare |
$597.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Humana Medicare |
$543.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG CHEST PA & LATERAL WITH BILAT OBLIQUES 4 VIEWS
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
H3240129
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG CHEST PA & LATERAL WITH BILAT OBLIQUES 4 VIEWS
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
H3240129
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$700.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$637.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$700.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$637.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$637.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.20
|
| Rate for Payer: University Health Alliance Commercial |
$86.36
|
|
|
HCHG CHEST PA ONLY 1 VIEW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240116
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$478.55 |
| Max. Negotiated Rate |
$546.11 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
|
|
HCHG CHEST PA ONLY 1 VIEW
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240116
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$557.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.50
|
| Rate for Payer: AlohaCare Medicare |
$506.70
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Devoted Health Medicare |
$557.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Humana Medicare |
$506.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.70
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HCHG CHEST SPEC 1 VIEW
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3200258
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$478.55 |
| Max. Negotiated Rate |
$546.11 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
|
|
HCHG CHEST SPEC 1 VIEW
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3200258
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$557.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.50
|
| Rate for Payer: AlohaCare Medicare |
$506.70
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Devoted Health Medicare |
$557.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Humana Medicare |
$506.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.70
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HCHG CHLAMYDIA PCR
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060124
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$228.69 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$207.90
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$228.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Humana Medicare |
$207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
