|
HCHG FLOW CYTOMETRY TC 1ST MARKER
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
H3110272
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$483.65 |
| Max. Negotiated Rate |
$551.93 |
| Rate for Payer: Cash Price |
$369.85
|
| Rate for Payer: Health Management Network Commercial |
$483.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$512.10
|
| Rate for Payer: MDX Hawaii PPO |
$551.93
|
|
|
HCHG FLOW CYTOMETRY TC 1ST MARKER
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
H3110272
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$563.31 |
| Rate for Payer: AlohaCare Medicaid |
$284.50
|
| Rate for Payer: AlohaCare Medicare |
$512.10
|
| Rate for Payer: Cash Price |
$369.85
|
| Rate for Payer: Cash Price |
$369.85
|
| Rate for Payer: Devoted Health Medicare |
$563.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$512.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$483.65
|
| Rate for Payer: Humana Medicare |
$512.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$512.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$512.10
|
| Rate for Payer: MDX Hawaii PPO |
$551.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$512.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$512.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$512.10
|
| Rate for Payer: University Health Alliance Commercial |
$152.44
|
|
|
HCHG FLOW CYTOMETRY TC ADD MRKS
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
HCPCS 88185
|
| Hospital Charge Code |
H3110274
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$650.43 |
| Rate for Payer: AlohaCare Medicaid |
$328.50
|
| Rate for Payer: AlohaCare Medicare |
$591.30
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Devoted Health Medicare |
$650.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$591.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$624.15
|
| Rate for Payer: Health Management Network Commercial |
$558.45
|
| Rate for Payer: Humana Medicare |
$591.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$591.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$335.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$591.30
|
| Rate for Payer: MDX Hawaii PPO |
$637.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$591.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$591.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$591.30
|
| Rate for Payer: University Health Alliance Commercial |
$86.75
|
|
|
HCHG FLOW CYTOMETRY TC ADD MRKS
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
HCPCS 88185
|
| Hospital Charge Code |
H3110274
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$558.45 |
| Max. Negotiated Rate |
$637.29 |
| Rate for Payer: Cash Price |
$427.05
|
| Rate for Payer: Health Management Network Commercial |
$558.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$591.30
|
| Rate for Payer: MDX Hawaii PPO |
$637.29
|
|
|
HCHG FLUORESCENT ANTIBODY SCREEN - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3021062
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
HCHG FLUORESCENT ANTIBODY SCREEN - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3021062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG FLUORO ARTHROCENTESIS SMALL JOINT
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
H3200947
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$779.50
|
| Rate for Payer: AlohaCare Medicare |
$1,403.10
|
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Devoted Health Medicare |
$1,543.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$392.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,403.10
|
| Rate for Payer: Health Management Network Commercial |
$1,325.15
|
| Rate for Payer: Humana Medicare |
$1,403.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,403.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,403.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,512.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,403.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,403.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,403.10
|
| Rate for Payer: University Health Alliance Commercial |
$1,136.36
|
|
|
HCHG FLUORO ARTHROCENTESIS SMALL JOINT
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
H3200947
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,325.15 |
| Max. Negotiated Rate |
$1,512.23 |
| Rate for Payer: Cash Price |
$1,013.35
|
| Rate for Payer: Health Management Network Commercial |
$1,325.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,403.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,512.23
|
|
|
HCHG FLUORS NONINF AGENT AB - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3001096
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG FLUORS NONINF AGENT AB - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3001096
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HCHG FNA WO IMG GUID
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
H4501092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG FNA WO IMG GUID
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
H4501092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,223.54 |
| Rate for Payer: AlohaCare Medicaid |
$1,123.00
|
| Rate for Payer: AlohaCare Medicare |
$2,021.40
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$2,223.54
|
| 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 |
$2,021.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,021.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,021.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,021.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,021.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,021.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,637.11
|
|
|
HCHG FOLATE RBC
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 82747
|
| Hospital Charge Code |
H3010616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: AlohaCare Medicaid |
$170.00
|
| Rate for Payer: AlohaCare Medicare |
$306.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Devoted Health Medicare |
$336.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$306.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.65
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Humana Medicare |
$306.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.00
|
| Rate for Payer: MDX Hawaii PPO |
$329.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$306.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.00
|
| Rate for Payer: University Health Alliance Commercial |
$44.77
|
|
|
HCHG FOLATE RBC
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 82747
|
| Hospital Charge Code |
H3010616
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$289.00 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.00
|
| Rate for Payer: MDX Hawaii PPO |
$329.80
|
|
|
HCHG FOLIC ACID-SERUM
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
H3010620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
|
|
HCHG FOLIC ACID-SERUM
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
H3010620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: AlohaCare Medicaid |
$108.00
|
| Rate for Payer: AlohaCare Medicare |
$194.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$213.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.70
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Humana Medicare |
$194.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.40
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.40
|
| Rate for Payer: University Health Alliance Commercial |
$38.00
|
|
|
HCHG FOOT (2 VIEWS)
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
H3200408
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| 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 |
$16.41
|
| 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 |
$17.57
|
| 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 |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
HCHG FOOT (2 VIEWS)
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
H3200408
|
|
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 FOOT 3 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
H3200406
|
|
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 FOOT 3 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
H3200406
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.08 |
| 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 |
$19.08
|
| 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 |
$20.03
|
| 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 |
$19.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HCHG FOOT PORT, 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
H3200410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| 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 |
$16.41
|
| 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 |
$17.57
|
| 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 |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
HCHG FOOT PORT, 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
H3200410
|
|
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 FOREARM 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
H3200412
|
|
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 |
$56.28
|
|
|
HCHG FOREARM 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
H3200412
|
|
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 FOREARM PORT 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
H3200414
|
|
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 |
$56.28
|
|
