|
HCHG EXAM SURG SPECIMEN
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200346
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$2,875.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,452.50
|
| Rate for Payer: AlohaCare Medicare |
$2,614.50
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Devoted Health Medicare |
$2,875.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,614.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$558.25
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Humana Medicare |
$2,614.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,614.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,481.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,614.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,614.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,614.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,614.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.66
|
|
|
HCHG EXAM SURG SPECIMEN
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200346
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,469.25 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,614.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
|
|
HCHG EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
H4501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$3,484.24 |
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,232.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
|
|
HCHG EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$3,592.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
H4501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,796.00
|
| Rate for Payer: AlohaCare Medicare |
$3,232.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Cash Price |
$2,334.80
|
| Rate for Payer: Devoted Health Medicare |
$3,556.08
|
| 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 |
$3,232.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,412.40
|
| Rate for Payer: Health Management Network Commercial |
$3,053.20
|
| Rate for Payer: Humana Medicare |
$3,232.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,232.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,232.80
|
| Rate for Payer: MDX Hawaii PPO |
$3,484.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,232.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,232.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,232.80
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG EXPL PENETR WOUND ABD
|
Facility
|
IP
|
$7,738.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
H4500442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,577.30 |
| Max. Negotiated Rate |
$7,505.86 |
| Rate for Payer: Cash Price |
$5,029.70
|
| Rate for Payer: Health Management Network Commercial |
$6,577.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,964.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,505.86
|
|
|
HCHG EXPL PENETR WOUND ABD
|
Facility
|
OP
|
$7,738.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
H4500442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,660.62 |
| Rate for Payer: AlohaCare Medicaid |
$3,869.00
|
| Rate for Payer: AlohaCare Medicare |
$6,964.20
|
| Rate for Payer: Cash Price |
$5,029.70
|
| Rate for Payer: Cash Price |
$5,029.70
|
| Rate for Payer: Devoted Health Medicare |
$7,660.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6,964.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,351.10
|
| Rate for Payer: Health Management Network Commercial |
$6,577.30
|
| Rate for Payer: Humana Medicare |
$6,964.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,964.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,964.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,505.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,964.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,964.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,964.20
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG EXPL PENETR WOUND EXTREM
|
Facility
|
OP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
H4500446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,869.81 |
| Rate for Payer: AlohaCare Medicaid |
$2,459.50
|
| Rate for Payer: AlohaCare Medicare |
$4,427.10
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Devoted Health Medicare |
$4,869.81
|
| 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 |
$4,427.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,673.05
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: Humana Medicare |
$4,427.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,427.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,427.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,427.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,427.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,427.10
|
| Rate for Payer: University Health Alliance Commercial |
$3,585.46
|
|
|
HCHG EXPL PENETR WOUND EXTREM
|
Facility
|
IP
|
$4,919.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
H4500446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,181.15 |
| Max. Negotiated Rate |
$4,771.43 |
| Rate for Payer: Cash Price |
$3,197.35
|
| Rate for Payer: Health Management Network Commercial |
$4,181.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,427.10
|
| Rate for Payer: MDX Hawaii PPO |
$4,771.43
|
|
|
HCHG FACIAL BONES MIN 3 VIEWS
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
H3200358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$741.51 |
| Rate for Payer: AlohaCare Medicaid |
$374.50
|
| Rate for Payer: AlohaCare Medicare |
$674.10
|
| Rate for Payer: Cash Price |
$486.85
|
| Rate for Payer: Cash Price |
$486.85
|
| Rate for Payer: Devoted Health Medicare |
$741.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$674.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$636.65
|
| Rate for Payer: Humana Medicare |
$674.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$674.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$381.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$674.10
|
| Rate for Payer: MDX Hawaii PPO |
$726.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$674.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$674.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$674.10
|
| Rate for Payer: University Health Alliance Commercial |
$87.39
|
|
|
HCHG FACIAL BONES MIN 3 VIEWS
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
H3200358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$636.65 |
| Max. Negotiated Rate |
$726.53 |
| Rate for Payer: Cash Price |
$486.85
|
| Rate for Payer: Health Management Network Commercial |
$636.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$674.10
|
| Rate for Payer: MDX Hawaii PPO |
$726.53
|
|
|
HCHG FACTOR II ACTIVITY CLOTTING
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
H3000208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG FACTOR II ACTIVITY CLOTTING
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
H3000208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.98 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.98
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.56
|
|
|
HCHG FACTOR V
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
H3100155
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$449.46 |
| Rate for Payer: AlohaCare Medicaid |
$227.00
|
| Rate for Payer: AlohaCare Medicare |
$408.60
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Devoted Health Medicare |
$449.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$408.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.37
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$408.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$408.60
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$408.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$408.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$408.60
|
| Rate for Payer: University Health Alliance Commercial |
$154.23
|
|
|
HCHG FACTOR V
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
H3100155
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.60
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
HCHG FACTOR V ACTIVITY CLOTTING
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
H3000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
|
|
HCHG FACTOR V ACTIVITY CLOTTING
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 85220
|
| Hospital Charge Code |
H3000210
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$117.90
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Devoted Health Medicare |
$129.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.65
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Humana Medicare |
$117.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.90
|
| Rate for Payer: University Health Alliance Commercial |
$45.62
|
|
|
HCHG FACTOR VII ACTIVITY CLOTTING
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
H3000212
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: AlohaCare Medicaid |
$66.00
|
| Rate for Payer: AlohaCare Medicare |
$118.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$130.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Humana Medicare |
$118.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.80
|
| Rate for Payer: University Health Alliance Commercial |
$46.29
|
|
|
HCHG FACTOR VII ACTIVITY CLOTTING
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 85230
|
| Hospital Charge Code |
H3000212
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
|
|
HCHG FACTOR VIII ACTIVITY
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
H3050138
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
|
|
HCHG FACTOR VIII ACTIVITY
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 85240
|
| Hospital Charge Code |
H3050138
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: AlohaCare Medicaid |
$66.00
|
| Rate for Payer: AlohaCare Medicare |
$118.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$130.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Humana Medicare |
$118.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.80
|
| Rate for Payer: University Health Alliance Commercial |
$46.29
|
|
|
HCHG FACTOR VIII RISTOCET COFACT 90
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
H3050148
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
HCHG FACTOR VIII RISTOCET COFACT 90
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 85245
|
| Hospital Charge Code |
H3050148
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$149.40
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$164.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$33.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.94
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$149.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.40
|
| Rate for Payer: University Health Alliance Commercial |
$59.31
|
|
|
HCHG FACTOR VIII VON WILL AG
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
H3050150
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$149.40
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$164.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$33.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.94
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$149.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.40
|
| Rate for Payer: University Health Alliance Commercial |
$59.31
|
|
|
HCHG FACTOR VIII VON WILL AG
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 85246
|
| Hospital Charge Code |
H3050150
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
HCHG FACTOR X ACTIVITY CLOTTING
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
H3000214
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: AlohaCare Medicaid |
$66.00
|
| Rate for Payer: AlohaCare Medicare |
$118.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$130.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.90
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Humana Medicare |
$118.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.80
|
| Rate for Payer: University Health Alliance Commercial |
$46.29
|
|
