|
HCHG COLD AGGLUTININS
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 86157
|
| Hospital Charge Code |
H3020436
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.06 |
| 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 |
$11.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.06
|
| 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 |
$11.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.80
|
| Rate for Payer: University Health Alliance Commercial |
$20.85
|
|
|
HCHG COLD AGGLUTININS
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 86157
|
| Hospital Charge Code |
H3020436
|
|
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 COLLECT BLD VIA EST CENTRAL/PERIPHERAL CATH VENOUS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
H4500900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$271.60 |
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Health Management Network Commercial |
$238.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.00
|
| Rate for Payer: MDX Hawaii PPO |
$271.60
|
|
|
HCHG COLLECT BLD VIA EST CENTRAL/PERIPHERAL CATH VENOUS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
H4500900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$252.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Devoted Health Medicare |
$277.20
|
| 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 |
$252.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.00
|
| Rate for Payer: Health Management Network Commercial |
$238.00
|
| Rate for Payer: Humana Medicare |
$252.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.00
|
| Rate for Payer: MDX Hawaii PPO |
$271.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$252.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$252.00
|
| Rate for Payer: University Health Alliance Commercial |
$204.09
|
|
|
HCHG COLLECT BLOOD FROM PICC
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
H3001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$252.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Devoted Health Medicare |
$277.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$252.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$266.00
|
| Rate for Payer: Health Management Network Commercial |
$238.00
|
| Rate for Payer: Humana Medicare |
$252.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$142.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.00
|
| Rate for Payer: MDX Hawaii PPO |
$271.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$252.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$252.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$252.00
|
| Rate for Payer: University Health Alliance Commercial |
$204.09
|
|
|
HCHG COLLECT BLOOD FROM PICC
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
H3001111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$271.60 |
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Health Management Network Commercial |
$238.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.00
|
| Rate for Payer: MDX Hawaii PPO |
$271.60
|
|
|
HCHG COLLECTION VENOUS BLD, VENIPUNCTURE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
H3001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: AlohaCare Medicaid |
$32.00
|
| Rate for Payer: AlohaCare Medicare |
$57.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Devoted Health Medicare |
$63.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.80
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Humana Medicare |
$57.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.60
|
| Rate for Payer: MDX Hawaii PPO |
$62.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.60
|
| Rate for Payer: University Health Alliance Commercial |
$46.65
|
|
|
HCHG COLLECTION VENOUS BLD, VENIPUNCTURE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
H3001106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$62.08 |
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.60
|
| Rate for Payer: MDX Hawaii PPO |
$62.08
|
|
|
HCHG COLONOSCOPY - DIAGNOSTIC
|
Facility
|
OP
|
$2,716.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
H4501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,358.00
|
| Rate for Payer: AlohaCare Medicare |
$2,444.40
|
| Rate for Payer: Cash Price |
$1,765.40
|
| Rate for Payer: Cash Price |
$1,765.40
|
| Rate for Payer: Devoted Health Medicare |
$2,688.84
|
| 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 |
$2,444.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,580.20
|
| Rate for Payer: Health Management Network Commercial |
$2,308.60
|
| Rate for Payer: Humana Medicare |
$2,444.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,444.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,444.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,634.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,444.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,444.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,444.40
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG COLONOSCOPY - DIAGNOSTIC
|
Facility
|
IP
|
$2,716.00
|
|
|
Service Code
|
HCPCS 45378
|
| Hospital Charge Code |
H4501101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,308.60 |
| Max. Negotiated Rate |
$2,634.52 |
| Rate for Payer: Cash Price |
$1,765.40
|
| Rate for Payer: Health Management Network Commercial |
$2,308.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,444.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,634.52
|
|
|
HCHG COMPATIB AHG 1 UNIT
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
H3900130
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$339.57 |
| Rate for Payer: AlohaCare Medicaid |
$171.50
|
| Rate for Payer: AlohaCare Medicare |
$308.70
|
| Rate for Payer: Cash Price |
$222.95
|
| Rate for Payer: Cash Price |
$222.95
|
| Rate for Payer: Devoted Health Medicare |
$339.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Humana Medicare |
$308.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$308.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$308.70
|
| Rate for Payer: MDX Hawaii PPO |
$332.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$308.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.70
|
| Rate for Payer: University Health Alliance Commercial |
$250.01
|
|
|
HCHG COMPATIB AHG 1 UNIT
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
H3900130
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$291.55 |
| Max. Negotiated Rate |
$332.71 |
| Rate for Payer: Cash Price |
$222.95
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$308.70
|
| Rate for Payer: MDX Hawaii PPO |
$332.71
|
|
|
HCHG COMPATIB AHG 1 UNIT
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
K3000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$339.57 |
| Rate for Payer: AlohaCare Medicaid |
$171.50
|
| Rate for Payer: AlohaCare Medicare |
$308.70
|
| Rate for Payer: Cash Price |
$222.95
|
| Rate for Payer: Cash Price |
$222.95
|
| Rate for Payer: Devoted Health Medicare |
$339.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Humana Medicare |
$308.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$308.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$308.70
|
| Rate for Payer: MDX Hawaii PPO |
$332.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$308.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.70
|
| Rate for Payer: University Health Alliance Commercial |
$250.01
|
|
|
HCHG COMPATIB AHG 1 UNIT
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
K3000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$291.55 |
| Max. Negotiated Rate |
$332.71 |
| Rate for Payer: Cash Price |
$222.95
|
| Rate for Payer: Health Management Network Commercial |
$291.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$308.70
|
| Rate for Payer: MDX Hawaii PPO |
$332.71
|
|
|
HCHG COMPATIB BLD INC 1 UNIT
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
H3900152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$865.26 |
| Rate for Payer: AlohaCare Medicaid |
$437.00
|
| Rate for Payer: AlohaCare Medicare |
$786.60
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Devoted Health Medicare |
$865.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$786.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Humana Medicare |
$786.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$445.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$786.60
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$786.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$786.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$786.60
|
| Rate for Payer: University Health Alliance Commercial |
$637.06
|
|
|
HCHG COMPATIB BLD INC 1 UNIT
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 86921
|
| Hospital Charge Code |
H3900152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
|
|
HCHG COMPLEMENT C2
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3020438
|
|
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 COMPLEMENT C2
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3020438
|
|
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 COMPLEMENT C3
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3020440
|
|
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 COMPLEMENT C3
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3020440
|
|
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 COMPLEMENT C4
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3020442
|
|
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 COMPLEMENT C4
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3020442
|
|
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 COMPLEX DRAINAGE, WOUND
|
Facility
|
IP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
H4500920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,173.55 |
| Max. Negotiated Rate |
$7,045.11 |
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,536.70
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
|
|
HCHG COMPLEX DRAINAGE, WOUND
|
Facility
|
OP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
H4500920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,190.37 |
| Rate for Payer: AlohaCare Medicaid |
$3,631.50
|
| Rate for Payer: AlohaCare Medicare |
$6,536.70
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Devoted Health Medicare |
$7,190.37
|
| 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 |
$6,536.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,899.85
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Humana Medicare |
$6,536.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,536.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,536.70
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,536.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,536.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,536.70
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG COMPREHENSIVE METABOLIC PROF
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
H3010410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$183.15 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$166.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$183.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.56
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$166.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.50
|
| Rate for Payer: University Health Alliance Commercial |
$27.32
|
|
