|
HCHG HUMERUS, MIN 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
H3200456
|
|
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 HUMERUS PORT, MIN 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
H3200458
|
|
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 HUMERUS PORT, MIN 2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
H3200458
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| 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 |
$18.84
|
| 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 |
$20.64
|
| 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 |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$61.20
|
|
|
HCHG IADNA CYTOMEGALOVIRUS QUATIFICATION - 90
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060786
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$228.69 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$207.90
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$228.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Humana Medicare |
$207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG IADNA CYTOMEGALOVIRUS QUATIFICATION - 90
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060786
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
|
|
HCHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB - 90
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
H3060791
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicare |
$324.90
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Devoted Health Medicare |
$357.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$324.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.68
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Humana Medicare |
$324.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$324.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$324.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB - 90
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
H3060791
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
HCHG IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM - 90
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060792
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$478.17 |
| Rate for Payer: AlohaCare Medicaid |
$241.50
|
| Rate for Payer: AlohaCare Medicare |
$434.70
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Devoted Health Medicare |
$478.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Humana Medicare |
$434.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.70
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM - 90
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060792
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$410.55 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
|
|
HCHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
H3060735
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
H3060735
|
|
Hospital Revenue Code
|
306
|
| 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 I&D ABSCESS COMPLICAT/MULT
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
H4500464
|
|
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 I&D ABSCESS COMPLICAT/MULT
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
H4500464
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| 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 |
$4,035.20
|
|
|
HCHG I&D ABSC PERITONSILLAR
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
H4500466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$701.00
|
| Rate for Payer: AlohaCare Medicare |
$1,261.80
|
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Devoted Health Medicare |
$1,387.98
|
| 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 |
$1,261.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,331.90
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: Humana Medicare |
$1,261.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,261.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,261.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,261.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,261.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,261.80
|
| Rate for Payer: University Health Alliance Commercial |
$1,021.92
|
|
|
HCHG I&D ABSC PERITONSILLAR
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
H4500466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,191.70 |
| Max. Negotiated Rate |
$1,359.94 |
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,261.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
|
|
HCHG I&D ABSC RETROPHARYNG INTRA
|
Facility
|
OP
|
$12,725.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
H4500470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$12,597.75 |
| Rate for Payer: AlohaCare Medicaid |
$6,362.50
|
| Rate for Payer: AlohaCare Medicare |
$11,452.50
|
| Rate for Payer: Cash Price |
$8,271.25
|
| Rate for Payer: Cash Price |
$8,271.25
|
| Rate for Payer: Devoted Health Medicare |
$12,597.75
|
| 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 |
$11,452.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,088.75
|
| Rate for Payer: Health Management Network Commercial |
$10,816.25
|
| Rate for Payer: Humana Medicare |
$11,452.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,452.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$11,452.50
|
| Rate for Payer: MDX Hawaii PPO |
$12,343.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11,452.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$11,452.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$11,452.50
|
| Rate for Payer: University Health Alliance Commercial |
$9,275.25
|
|
|
HCHG I&D ABSC RETROPHARYNG INTRA
|
Facility
|
IP
|
$12,725.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
H4500470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10,816.25 |
| Max. Negotiated Rate |
$12,343.25 |
| Rate for Payer: Cash Price |
$8,271.25
|
| Rate for Payer: Health Management Network Commercial |
$10,816.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$11,452.50
|
| Rate for Payer: MDX Hawaii PPO |
$12,343.25
|
|
|
HCHG I&D ABSC SIMP/SNGL
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
H4500468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$616.50
|
| Rate for Payer: AlohaCare Medicare |
$1,109.70
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$1,220.67
|
| 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 |
$1,109.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,171.35
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$1,109.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,109.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,109.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,109.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,109.70
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG I&D ABSC SIMP/SNGL
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
H4500468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,109.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
H4500472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$622.50
|
| Rate for Payer: AlohaCare Medicare |
$1,120.50
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Devoted Health Medicare |
$1,232.55
|
| 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 |
$1,120.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,182.75
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: Humana Medicare |
$1,120.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,120.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,120.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,207.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,120.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,120.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,120.50
|
| Rate for Payer: University Health Alliance Commercial |
$907.48
|
|
|
HCHG I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
H4500472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,058.25 |
| Max. Negotiated Rate |
$1,207.65 |
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,120.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,207.65
|
|
|
HCHG I&D DP ABSC BURSA/HEMAT THIGH/
|
Facility
|
OP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
H4500474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,190.37 |
| Rate for Payer: AlohaCare Medicaid |
$3,631.50
|
| Rate for Payer: AlohaCare Medicare |
$6,536.70
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Devoted Health Medicare |
$7,190.37
|
| 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 |
$6,536.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,899.85
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Humana Medicare |
$6,536.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,536.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,536.70
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,536.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,536.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,536.70
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HCHG I&D DP ABSC BURSA/HEMAT THIGH/
|
Facility
|
IP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
H4500474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,173.55 |
| Max. Negotiated Rate |
$7,045.11 |
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,536.70
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
|
|
HCHG IDENT AEROBIC ISOL 1
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
H3060250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: AlohaCare Medicaid |
$75.50
|
| Rate for Payer: AlohaCare Medicare |
$135.90
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Devoted Health Medicare |
$149.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Humana Medicare |
$135.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.90
|
| Rate for Payer: MDX Hawaii PPO |
$146.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.90
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT AEROBIC ISOL 1
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
H3060250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.90
|
| Rate for Payer: MDX Hawaii PPO |
$146.47
|
|
