|
HCHG CREATINE CLEARANCE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
H3010428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
|
|
HCHG CREATININE BLOOD
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
H3010432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$74.69 |
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: MDX Hawaii PPO |
$74.69
|
|
|
HCHG CREATININE BLOOD
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
H3010432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$76.23 |
| Rate for Payer: AlohaCare Medicaid |
$38.50
|
| Rate for Payer: AlohaCare Medicare |
$69.30
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Devoted Health Medicare |
$76.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.12
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Humana Medicare |
$69.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.30
|
| Rate for Payer: MDX Hawaii PPO |
$74.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.30
|
| Rate for Payer: University Health Alliance Commercial |
$13.25
|
|
|
HCHG CREATININE BODY FLUID
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
H3010442
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: AlohaCare Medicaid |
$39.00
|
| Rate for Payer: AlohaCare Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Devoted Health Medicare |
$77.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Humana Medicare |
$70.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.20
|
| Rate for Payer: MDX Hawaii PPO |
$75.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HCHG CREATININE BODY FLUID
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
H3010442
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.20
|
| Rate for Payer: MDX Hawaii PPO |
$75.66
|
|
|
HCHG CREATININE URINE
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
H3010440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.20
|
| Rate for Payer: MDX Hawaii PPO |
$75.66
|
|
|
HCHG CREATININE URINE
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
H3010440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: AlohaCare Medicaid |
$39.00
|
| Rate for Payer: AlohaCare Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Devoted Health Medicare |
$77.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Humana Medicare |
$70.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.20
|
| Rate for Payer: MDX Hawaii PPO |
$75.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HCHG CRYOGLOBULIN QUAL REFLEX
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82595
|
| Hospital Charge Code |
H3010450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$48.51 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$44.10
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$48.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$44.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.10
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HCHG CRYOGLOBULIN QUAL REFLEX
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82595
|
| Hospital Charge Code |
H3010450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
HCHG CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
H3020965
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$79.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$87.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$26.34
|
|
|
HCHG CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
H3020965
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
|
HCHG CRYPTOCOCCUS ANTIGEN, SERUM
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
H3021038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$79.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$87.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$26.34
|
|
|
HCHG CRYPTOCOCCUS ANTIGEN, SERUM
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
H3021038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
|
HCHG CRYPTOSPORIDIUM DETECTION BY IF
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
H3060624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG CRYPTOSPORIDIUM DETECTION BY IF
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
H3060624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG CRYSTAL EXAM-BODY FLD
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
H3090112
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$119.70
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$131.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$119.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$18.48
|
|
|
HCHG CRYSTAL EXAM-BODY FLD
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
H3090112
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HCHG C-SPINE 2-3 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200292
|
|
Hospital Revenue Code
|
320
|
| 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 C-SPINE 2-3 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200292
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| 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 |
$19.78
|
| 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 |
$21.66
|
| 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 |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C-SPINE 2-3 VIEWS PORT
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: AlohaCare Medicaid |
$246.50
|
| Rate for Payer: AlohaCare Medicare |
$443.70
|
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Devoted Health Medicare |
$488.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$443.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Humana Medicare |
$443.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$443.70
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$443.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$443.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$443.70
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C-SPINE 2-3 VIEWS PORT
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$419.05 |
| Max. Negotiated Rate |
$478.21 |
| Rate for Payer: Cash Price |
$320.45
|
| Rate for Payer: Health Management Network Commercial |
$419.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.70
|
| Rate for Payer: MDX Hawaii PPO |
$478.21
|
|
|
HCHG C-SPINE 4 OR 5 VIEWS
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
H3200917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$750.42 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$682.20
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$750.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$682.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$682.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.20
|
| Rate for Payer: University Health Alliance Commercial |
$105.14
|
|
|
HCHG C-SPINE 4 OR 5 VIEWS
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
H3200917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
HCHG C- SPINE AP & LAT ONLY
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| 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 |
$19.78
|
| 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 |
$21.66
|
| 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 |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C- SPINE AP & LAT ONLY
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200226
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
