|
HCHG FACTOR X ACTIVITY CLOTTING
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 85260
|
| Hospital Charge Code |
H3000214
|
|
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 XI ACTIVITY CLOTTING
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
H3000216
|
|
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 XI ACTIVITY CLOTTING
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 85270
|
| Hospital Charge Code |
H3000216
|
|
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 XII ACTIVITY CLOTTING
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
H3000218
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
|
HCHG FACTOR XII ACTIVITY CLOTTING
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 85280
|
| Hospital Charge Code |
H3000218
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$140.58 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$127.80
|
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Devoted Health Medicare |
$140.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.35
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$127.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.80
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HCHG FAT FECAL QNT 90
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
H3010594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HCHG FAT FECAL QNT 90
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
H3010594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$120.78 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$109.80
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$120.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$109.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.80
|
| Rate for Payer: University Health Alliance Commercial |
$43.42
|
|
|
HCHG FECAL FAT, QUALITATIVE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
H3011552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$38.61 |
| Rate for Payer: AlohaCare Medicaid |
$19.50
|
| Rate for Payer: AlohaCare Medicare |
$35.10
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Devoted Health Medicare |
$38.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Humana Medicare |
$35.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.10
|
| Rate for Payer: University Health Alliance Commercial |
$13.15
|
|
|
HCHG FECAL FAT, QUALITATIVE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
H3011552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
|
|
HCHG FECES CULTURE AEROBIC BACT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
H3000200
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$154.44 |
| Rate for Payer: AlohaCare Medicaid |
$78.00
|
| Rate for Payer: AlohaCare Medicare |
$140.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$154.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$140.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.40
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HCHG FECES CULTURE AEROBIC BACT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
H3000200
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HCHG FERRITIN LEVEL RIA
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
H3010600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$209.88 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$190.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$209.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.63
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$190.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.80
|
| Rate for Payer: University Health Alliance Commercial |
$29.56
|
|
|
HCHG FERRITIN LEVEL RIA
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
H3010600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
HCHG FETAL FIBRONECTIN
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
H3010602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$400.95 |
| Rate for Payer: AlohaCare Medicaid |
$202.50
|
| Rate for Payer: AlohaCare Medicare |
$364.50
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Devoted Health Medicare |
$400.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$80.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$364.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$239.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.41
|
| Rate for Payer: Health Management Network Commercial |
$344.25
|
| Rate for Payer: Humana Medicare |
$364.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$364.50
|
| Rate for Payer: MDX Hawaii PPO |
$392.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$364.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$364.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$364.50
|
| Rate for Payer: University Health Alliance Commercial |
$166.48
|
|
|
HCHG FETAL FIBRONECTIN
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
H3010602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$392.85 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Health Management Network Commercial |
$344.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$364.50
|
| Rate for Payer: MDX Hawaii PPO |
$392.85
|
|
|
HCHG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
H3050154
|
|
Hospital Revenue Code
|
305
|
| 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 FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
H3050154
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.72 |
| 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 |
$11.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.72
|
| 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 |
$11.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$21.96
|
|
|
HCHG FILALRIOSIS AB 90
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
H3020512
|
|
Hospital Revenue Code
|
302
|
| 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 FILALRIOSIS AB 90
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
H3020512
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.60 |
| 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 |
$12.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.01
|
| 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 |
$12.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$24.88
|
|
|
HCHG FINE NDL ASP SM-BX EX
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
H3110180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.80
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
|
|
HCHG FINE NDL ASP SM-BX EX
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
H3110180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$407.88 |
| Rate for Payer: AlohaCare Medicaid |
$206.00
|
| Rate for Payer: AlohaCare Medicare |
$370.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Devoted Health Medicare |
$407.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$370.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Humana Medicare |
$370.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$370.80
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$370.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$370.80
|
| Rate for Payer: University Health Alliance Commercial |
$262.68
|
|
|
HCHG FINGERS MIN 2 VWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
H3200374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.98 |
| 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 |
$14.98
|
| 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 |
$15.73
|
| 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 |
$14.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$54.96
|
|
|
HCHG FINGERS MIN 2 VWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
H3200374
|
|
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 FLECAINIDE - 90
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 80181
|
| Hospital Charge Code |
H3011765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
HCHG FLECAINIDE - 90
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 80181
|
| Hospital Charge Code |
H3011765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$136.62 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicare |
$124.20
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$136.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$124.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.20
|
| Rate for Payer: University Health Alliance Commercial |
$100.59
|
|
