|
HCHG ENTEROVIRUS PROBE & REVRS TRNS - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
H3060795
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG ENUCLEATE/EXCISE HEMORRHOID
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
H4500430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,019.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,030.00
|
| Rate for Payer: AlohaCare Medicare |
$3,654.00
|
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Devoted Health Medicare |
$4,019.40
|
| 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 |
$3,654.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,857.00
|
| Rate for Payer: Health Management Network Commercial |
$3,451.00
|
| Rate for Payer: Humana Medicare |
$3,654.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,654.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,654.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,938.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,654.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,654.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,654.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,959.33
|
|
|
HCHG ENUCLEATE/EXCISE HEMORRHOID
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
H4500430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,451.00 |
| Max. Negotiated Rate |
$3,938.20 |
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Health Management Network Commercial |
$3,451.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,654.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,938.20
|
|
|
HCHG EOSIN COUNT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
H3050132
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$18.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Devoted Health Medicare |
$19.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$18.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.00
|
| Rate for Payer: University Health Alliance Commercial |
$6.57
|
|
|
HCHG EOSIN COUNT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
H3050132
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HCHG EOSIN NASAL OR SPUTUM
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
H3090114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
HCHG EOSIN NASAL OR SPUTUM
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 89190
|
| Hospital Charge Code |
H3090114
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$36.90
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$40.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.79
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Humana Medicare |
$36.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.90
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG EOSIN OTHER SOURCE
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
H3060186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$63.90
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$70.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$63.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.90
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG EOSIN OTHER SOURCE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
H3060186
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG ERX PHARMACY (UBC 250/636)
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
H2500005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: AlohaCare Medicaid |
$0.01
|
| Rate for Payer: AlohaCare Medicare |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Devoted Health Medicare |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network Commercial |
$0.01
|
| Rate for Payer: Humana Medicare |
$0.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.01
|
| Rate for Payer: MDX Hawaii PPO |
$0.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.01
|
| Rate for Payer: University Health Alliance Commercial |
$0.01
|
|
|
HCHG ERX PHARMACY (UBC 250/636)
|
Facility
|
IP
|
$0.01
|
|
| Hospital Charge Code |
H2500005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Management Network Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.01
|
| Rate for Payer: MDX Hawaii PPO |
$0.01
|
|
|
HCHG ERYTHROPOIETIN 90
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
H3010570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.79 |
| Max. Negotiated Rate |
$274.23 |
| Rate for Payer: AlohaCare Medicaid |
$138.50
|
| Rate for Payer: AlohaCare Medicare |
$249.30
|
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Devoted Health Medicare |
$274.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$249.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.79
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Humana Medicare |
$249.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$141.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$249.30
|
| Rate for Payer: MDX Hawaii PPO |
$268.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$249.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$249.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$249.30
|
| Rate for Payer: University Health Alliance Commercial |
$48.58
|
|
|
HCHG ERYTHROPOIETIN 90
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 82668
|
| Hospital Charge Code |
H3010570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$235.45 |
| Max. Negotiated Rate |
$268.69 |
| Rate for Payer: Cash Price |
$180.05
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.30
|
| Rate for Payer: MDX Hawaii PPO |
$268.69
|
|
|
HCHG ESR
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
K3050006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
HCHG ESR
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
K3050006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$66.33 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$60.30
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$66.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$60.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.30
|
| Rate for Payer: University Health Alliance Commercial |
$9.18
|
|
|
HCHG ESTRADIOL SERUM
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
H3010572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.40
|
| Rate for Payer: MDX Hawaii PPO |
$190.12
|
|
|
HCHG ESTRADIOL SERUM
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
H3010572
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: AlohaCare Medicaid |
$98.00
|
| Rate for Payer: AlohaCare Medicare |
$176.40
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Devoted Health Medicare |
$194.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$176.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.94
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: Humana Medicare |
$176.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.40
|
| Rate for Payer: MDX Hawaii PPO |
$190.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$176.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$176.40
|
| Rate for Payer: University Health Alliance Commercial |
$72.22
|
|
|
HCHG ESTRIOL SERUM UNCONJ
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
H3010574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
|
|
HCHG ESTRIOL SERUM UNCONJ
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 82677
|
| Hospital Charge Code |
H3010574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: AlohaCare Medicaid |
$86.50
|
| Rate for Payer: AlohaCare Medicare |
$155.70
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Devoted Health Medicare |
$171.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$155.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.18
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Humana Medicare |
$155.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$155.70
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$155.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$155.70
|
| Rate for Payer: University Health Alliance Commercial |
$62.51
|
|
|
HCHG ESTROGEN-SERUM TOTAL 90
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
H3010578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$56.05
|
|
|
HCHG ESTROGEN-SERUM TOTAL 90
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 82672
|
| Hospital Charge Code |
H3010578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG ETHYLENE GLYCOL
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
H3010592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
HCHG ETHYLENE GLYCOL
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 82693
|
| Hospital Charge Code |
H3010592
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$111.87 |
| Rate for Payer: AlohaCare Medicaid |
$56.50
|
| Rate for Payer: AlohaCare Medicare |
$101.70
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Devoted Health Medicare |
$111.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.90
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Humana Medicare |
$101.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.70
|
| Rate for Payer: University Health Alliance Commercial |
$38.52
|
|
|
HCHG EVAC SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
H4500438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG EVAC SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
H4500438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$734.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$807.84
|
| 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 |
$734.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$734.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$734.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$734.40
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
