|
HCHG HAND 2 VIEWS PORT
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| 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 |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| 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 |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
HCHG HAND 2 VIEWS PORT
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200430
|
|
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 HAND MIN 3 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
H3200428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.08 |
| 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 |
$19.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.03
|
| 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 |
$19.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HCHG HAND MIN 3 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
H3200428
|
|
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 HANGING DROP
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
H3060206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: AlohaCare Medicaid |
$22.50
|
| Rate for Payer: AlohaCare Medicare |
$40.50
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Devoted Health Medicare |
$44.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.82
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Humana Medicare |
$40.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.50
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG HANGING DROP
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
H3060206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.50
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
|
|
HCHG HAPTOGLOBIN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
H3010694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
HCHG HAPTOGLOBIN
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
H3010694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$95.04 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$86.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$95.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.58
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$86.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.40
|
| Rate for Payer: University Health Alliance Commercial |
$32.52
|
|
|
HCHG HCG QUAL URINE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
K3010049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HCHG HCG QUAL URINE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
K3010049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$139.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$126.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HCHG HCG QUANT TUMOR
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
H3010702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$220.77 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$200.70
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$220.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$200.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.70
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HCHG HCG QUANT TUMOR
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
H3010702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
HCHG HCG SO
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 84704
|
| Hospital Charge Code |
K3010062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
|
|
HCHG HCG SO
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 84704
|
| Hospital Charge Code |
K3010062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: AlohaCare Medicaid |
$56.00
|
| Rate for Payer: AlohaCare Medicare |
$100.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$110.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.29
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.80
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HCHG HCV GENOTYPING
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
H3020972
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$256.16 |
| Max. Negotiated Rate |
$1,343.43 |
| Rate for Payer: AlohaCare Medicaid |
$678.50
|
| Rate for Payer: AlohaCare Medicare |
$1,221.30
|
| Rate for Payer: Cash Price |
$882.05
|
| Rate for Payer: Cash Price |
$882.05
|
| Rate for Payer: Devoted Health Medicare |
$1,343.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$321.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,221.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$355.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$257.45
|
| Rate for Payer: Health Management Network Commercial |
$1,153.45
|
| Rate for Payer: Humana Medicare |
$1,221.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,221.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$692.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,221.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,316.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,221.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,221.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,221.30
|
| Rate for Payer: University Health Alliance Commercial |
$665.43
|
|
|
HCHG HCV GENOTYPING
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
H3020972
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,153.45 |
| Max. Negotiated Rate |
$1,316.29 |
| Rate for Payer: Cash Price |
$882.05
|
| Rate for Payer: Health Management Network Commercial |
$1,153.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,221.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,316.29
|
|
|
HCHG HCV-RNA QUANT TAQMAN 90
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
H3060212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: AlohaCare Medicaid |
$142.50
|
| Rate for Payer: AlohaCare Medicare |
$256.50
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Devoted Health Medicare |
$282.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$53.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$256.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.84
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Humana Medicare |
$256.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$256.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$256.50
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HCHG HCV-RNA QUANT TAQMAN 90
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
H3060212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
|
|
HCHG HDL - CHOLESTEROL
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
H3011594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HCHG HDL - CHOLESTEROL
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
H3011594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$56.70
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.19
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.70
|
| Rate for Payer: University Health Alliance Commercial |
$21.16
|
|
|
HCHG HEEL MIN 2 VIEWS
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
H3200432
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.55 |
| Max. Negotiated Rate |
$546.11 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
|
|
HCHG HEEL MIN 2 VIEWS
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
H3200432
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$557.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.50
|
| Rate for Payer: AlohaCare Medicare |
$506.70
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Devoted Health Medicare |
$557.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Humana Medicare |
$506.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.70
|
| Rate for Payer: University Health Alliance Commercial |
$53.87
|
|
|
HCHG HEEL PORT MIN 2 VIEWS
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
H3200436
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.55 |
| Max. Negotiated Rate |
$546.11 |
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
|
|
HCHG HEEL PORT MIN 2 VIEWS
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
H3200436
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$557.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.50
|
| Rate for Payer: AlohaCare Medicare |
$506.70
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Cash Price |
$365.95
|
| Rate for Payer: Devoted Health Medicare |
$557.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$506.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$478.55
|
| Rate for Payer: Humana Medicare |
$506.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$506.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$506.70
|
| Rate for Payer: MDX Hawaii PPO |
$546.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$506.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$506.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$506.70
|
| Rate for Payer: University Health Alliance Commercial |
$53.87
|
|
|
HCHG HEMATOCRIT
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
H3050156
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
