|
HCHG ELBOW COMPL ETE- PORT, 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
H3200324
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$507.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$558.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$507.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$55.57
|
|
|
HCHG ELBOW COMPL ETE- PORT, 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
H3200324
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
|
|
HCHG ELBOW MIN 3 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
H3200326
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| 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 |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$68.41
|
|
|
HCHG ELBOW MIN 3 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
H3200326
|
|
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 ELECTROLYTE PANEL
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
H3010568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
|
|
HCHG ELECTROLYTE PANEL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
H3010568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$101.97 |
| Rate for Payer: AlohaCare Medicaid |
$51.50
|
| Rate for Payer: AlohaCare Medicare |
$92.70
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Devoted Health Medicare |
$101.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.01
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Humana Medicare |
$92.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.70
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.70
|
| Rate for Payer: University Health Alliance Commercial |
$18.13
|
|
|
HCHG EMERGENCY FEE 1 NON-URGENT
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
H4500416
|
|
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 |
$814.50
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Devoted Health Medicare |
$895.95
|
| 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 |
$814.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$859.75
|
| Rate for Payer: Health Management Network Commercial |
$769.25
|
| Rate for Payer: Humana Medicare |
$814.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$814.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$814.50
|
| Rate for Payer: MDX Hawaii PPO |
$877.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$814.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$814.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$814.50
|
| Rate for Payer: University Health Alliance Commercial |
$659.65
|
|
|
HCHG EMERGENCY FEE 1 NON-URGENT
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
H4500416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$769.25 |
| Max. Negotiated Rate |
$877.85 |
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Health Management Network Commercial |
$769.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$814.50
|
| Rate for Payer: MDX Hawaii PPO |
$877.85
|
|
|
HCHG EMERGENCY FEE 2 URGENT I
|
Facility
|
OP
|
$1,610.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
H4500418
|
|
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 |
$1,449.00
|
| Rate for Payer: Cash Price |
$1,046.50
|
| Rate for Payer: Cash Price |
$1,046.50
|
| Rate for Payer: Cash Price |
$1,046.50
|
| Rate for Payer: Devoted Health Medicare |
$1,593.90
|
| 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 |
$1,449.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,529.50
|
| Rate for Payer: Health Management Network Commercial |
$1,368.50
|
| Rate for Payer: Humana Medicare |
$1,449.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,449.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,449.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,561.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,449.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,449.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,449.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,173.53
|
|
|
HCHG EMERGENCY FEE 2 URGENT I
|
Facility
|
IP
|
$1,610.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
H4500418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,368.50 |
| Max. Negotiated Rate |
$1,561.70 |
| Rate for Payer: Cash Price |
$1,046.50
|
| Rate for Payer: Health Management Network Commercial |
$1,368.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,449.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,561.70
|
|
|
HCHG EMERGENCY FEE 3 URGENT II
|
Facility
|
OP
|
$2,306.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
H4500420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$2,282.94 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$2,075.40
|
| Rate for Payer: Cash Price |
$1,498.90
|
| Rate for Payer: Cash Price |
$1,498.90
|
| Rate for Payer: Cash Price |
$1,498.90
|
| Rate for Payer: Devoted Health Medicare |
$2,282.94
|
| 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 |
$2,075.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,190.70
|
| Rate for Payer: Health Management Network Commercial |
$1,960.10
|
| Rate for Payer: Humana Medicare |
$2,075.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,075.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,075.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,236.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,075.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,075.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,075.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,680.84
|
|
|
HCHG EMERGENCY FEE 3 URGENT II
|
Facility
|
IP
|
$2,306.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
H4500420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,960.10 |
| Max. Negotiated Rate |
$2,236.82 |
| Rate for Payer: Cash Price |
$1,498.90
|
| Rate for Payer: Health Management Network Commercial |
$1,960.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,075.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,236.82
|
|
|
HCHG EMERGENCY FEE 4 EMERGENT I
|
Facility
|
IP
|
$3,839.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
H4500422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,263.15 |
| Max. Negotiated Rate |
$3,723.83 |
| Rate for Payer: Cash Price |
$2,495.35
|
| Rate for Payer: Health Management Network Commercial |
$3,263.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,455.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,723.83
|
|
|
HCHG EMERGENCY FEE 4 EMERGENT I
|
Facility
|
OP
|
$3,839.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
H4500422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$3,800.61 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$3,455.10
|
| Rate for Payer: Cash Price |
$2,495.35
|
| Rate for Payer: Cash Price |
$2,495.35
|
| Rate for Payer: Cash Price |
$2,495.35
|
| Rate for Payer: Devoted Health Medicare |
$3,800.61
|
| 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 |
$3,455.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,647.05
|
| Rate for Payer: Health Management Network Commercial |
$3,263.15
|
| Rate for Payer: Humana Medicare |
$3,455.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,455.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,455.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,723.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,455.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,455.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,455.10
|
| Rate for Payer: University Health Alliance Commercial |
$2,798.25
|
|
|
HCHG EMERGENCY FEE 5 EMERGENT II
|
Facility
|
OP
|
$6,263.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
H4500424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$6,200.37 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$5,636.70
|
| Rate for Payer: Cash Price |
$4,070.95
|
| Rate for Payer: Cash Price |
$4,070.95
|
| Rate for Payer: Cash Price |
$4,070.95
|
| Rate for Payer: Devoted Health Medicare |
$6,200.37
|
| 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 |
$5,636.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,949.85
|
| Rate for Payer: Health Management Network Commercial |
$5,323.55
|
| Rate for Payer: Humana Medicare |
$5,636.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,636.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,636.70
|
| Rate for Payer: MDX Hawaii PPO |
$6,075.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,636.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,636.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,636.70
|
| Rate for Payer: University Health Alliance Commercial |
$4,565.10
|
|
|
HCHG EMERGENCY FEE 5 EMERGENT II
|
Facility
|
IP
|
$6,263.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
H4500424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,323.55 |
| Max. Negotiated Rate |
$6,075.11 |
| Rate for Payer: Cash Price |
$4,070.95
|
| Rate for Payer: Health Management Network Commercial |
$5,323.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,636.70
|
| Rate for Payer: MDX Hawaii PPO |
$6,075.11
|
|
|
HCHG EMERGENCY FEE 6 CRITICAL CARE
|
Facility
|
OP
|
$8,511.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
H4500426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$8,425.89 |
| Rate for Payer: AlohaCare Medicaid |
$4,255.50
|
| Rate for Payer: AlohaCare Medicare |
$7,659.90
|
| Rate for Payer: Cash Price |
$5,532.15
|
| Rate for Payer: Cash Price |
$5,532.15
|
| Rate for Payer: Devoted Health Medicare |
$8,425.89
|
| 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 |
$7,659.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,085.45
|
| Rate for Payer: Health Management Network Commercial |
$7,234.35
|
| Rate for Payer: Humana Medicare |
$7,659.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,659.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,659.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,255.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,659.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,659.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,659.90
|
| Rate for Payer: University Health Alliance Commercial |
$6,203.67
|
|
|
HCHG EMERGENCY FEE 6 CRITICAL CARE
|
Facility
|
IP
|
$8,511.00
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
H4500426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,234.35 |
| Max. Negotiated Rate |
$8,255.67 |
| Rate for Payer: Cash Price |
$5,532.15
|
| Rate for Payer: Health Management Network Commercial |
$7,234.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,659.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,255.67
|
|
|
HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
H4500427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$725.00
|
| Rate for Payer: AlohaCare Medicare |
$1,305.00
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Devoted Health Medicare |
$1,435.50
|
| 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 |
$1,305.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,377.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Humana Medicare |
$1,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,056.90
|
|
|
HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
H4500427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,232.50 |
| Max. Negotiated Rate |
$1,406.50 |
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
|
|
HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
H4501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$725.00
|
| Rate for Payer: AlohaCare Medicare |
$1,305.00
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Devoted Health Medicare |
$1,435.50
|
| 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 |
$1,305.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,377.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Humana Medicare |
$1,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,056.90
|
|
|
HCHG EMERGENCY FEE 6 CRITICAL CARE EA ADDL 30MIN
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
H4501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,232.50 |
| Max. Negotiated Rate |
$1,406.50 |
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
|
|
HCHG ENDOMYSIAL AB IGG, RFLX TO TITER
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
H3021043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$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: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| 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 |
$7.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$67.06
|
|
|
HCHG ENDOMYSIAL AB IGG, RFLX TO TITER
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
H3021043
|
|
Hospital Revenue Code
|
302
|
| 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 ENTEROVIRUS PROBE & REVRS TRNS - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
H3060795
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
