|
HCHG C- SPINE FLEX/EXT ONLY 2-3VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200228
|
|
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 FLEX/EXT ONLY 2-3VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200228
|
|
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 LAT ONLY/SWIM 1 VIEW
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
H3200230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$535.59 |
| Rate for Payer: AlohaCare Medicaid |
$270.50
|
| Rate for Payer: AlohaCare Medicare |
$486.90
|
| Rate for Payer: Cash Price |
$351.65
|
| Rate for Payer: Cash Price |
$351.65
|
| Rate for Payer: Devoted Health Medicare |
$535.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$486.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$459.85
|
| Rate for Payer: Humana Medicare |
$486.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$275.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$486.90
|
| Rate for Payer: MDX Hawaii PPO |
$524.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$486.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$486.90
|
| Rate for Payer: University Health Alliance Commercial |
$48.36
|
|
|
HCHG C- SPINE LAT ONLY/SWIM 1 VIEW
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
H3200230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$459.85 |
| Max. Negotiated Rate |
$524.77 |
| Rate for Payer: Cash Price |
$351.65
|
| Rate for Payer: Health Management Network Commercial |
$459.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$486.90
|
| Rate for Payer: MDX Hawaii PPO |
$524.77
|
|
|
HCHG CULT ANAEROBIC ISOL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
H3060142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$157.50
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$173.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.47
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$157.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$157.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.50
|
| Rate for Payer: University Health Alliance Commercial |
$24.46
|
|
|
HCHG CULT ANAEROBIC ISOL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
H3060142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
HCHG CULT BACTERIAL MISC
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060144
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT BACTERIAL MISC
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060144
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULT BETA STREP
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
H3060146
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$99.90
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$109.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.63
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$99.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.90
|
| Rate for Payer: University Health Alliance Commercial |
$17.13
|
|
|
HCHG CULT BETA STREP
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
H3060146
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG CULT BLOOD
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
H3060148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: AlohaCare Medicaid |
$81.00
|
| Rate for Payer: AlohaCare Medicare |
$145.80
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Devoted Health Medicare |
$160.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$145.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$145.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$145.80
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$145.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$145.80
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
HCHG CULT BLOOD
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
H3060148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.80
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
|
|
HCHG CULT BODY FLUID
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT BODY FLUID
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULT CSF
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT CSF
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULT FUNGI BLOOD
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 87103
|
| Hospital Charge Code |
H3060158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$134.10
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$147.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.46
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$134.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.10
|
| Rate for Payer: University Health Alliance Commercial |
$23.31
|
|
|
HCHG CULT FUNGI BLOOD
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 87103
|
| Hospital Charge Code |
H3060158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG CULT FUNGI ISOLATION
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
H3060160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
|
|
HCHG CULT FUNGI ISOLATION
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
H3060160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: AlohaCare Medicaid |
$62.50
|
| Rate for Payer: AlohaCare Medicare |
$112.50
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Devoted Health Medicare |
$123.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.41
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Humana Medicare |
$112.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$21.72
|
|
|
HCHG CULT MISC
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
H3060168
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: AlohaCare Medicaid |
$56.00
|
| Rate for Payer: AlohaCare Medicare |
$100.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$110.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.39
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.80
|
| Rate for Payer: University Health Alliance Commercial |
$39.77
|
|
|
HCHG CULT MISC
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060166
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT MISC
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
H3060168
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
|
|
HCHG CULT MISC
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060166
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULT SPUTUM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
