|
HCHG IMMUNIZATION ADMINISTRATION, ONE VACCINE
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
H7710102
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$266.31 |
| Rate for Payer: AlohaCare Medicaid |
$134.50
|
| Rate for Payer: AlohaCare Medicare |
$242.10
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Devoted Health Medicare |
$266.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$242.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$255.55
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Humana Medicare |
$242.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.10
|
| Rate for Payer: MDX Hawaii PPO |
$260.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$242.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$242.10
|
| Rate for Payer: University Health Alliance Commercial |
$196.07
|
|
|
HCHG IMMUNIZATION ADMINISTRATION, ONE VACCINE
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
H7710102
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$228.65 |
| Max. Negotiated Rate |
$260.93 |
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.10
|
| Rate for Payer: MDX Hawaii PPO |
$260.93
|
|
|
HCHG IMMUNOASSAY ANAL MULT SO
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: AlohaCare Medicaid |
$114.00
|
| Rate for Payer: AlohaCare Medicare |
$205.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Devoted Health Medicare |
$225.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Humana Medicare |
$205.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.82
|
|
|
HCHG IMMUNOASSAY ANAL MULT SO
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
|
HCHG IMMUNODIFFUSION,GEL,QUAL,AB/AG
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86331
|
| Hospital Charge Code |
H3020913
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG IMMUNODIFFUSION,GEL,QUAL,AB/AG
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86331
|
| Hospital Charge Code |
H3020913
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$30.99
|
|
|
HCHG IMMUNO EA ADDL SNGL
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
H3120327
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$432.63 |
| Rate for Payer: AlohaCare Medicaid |
$218.50
|
| Rate for Payer: AlohaCare Medicare |
$393.30
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Devoted Health Medicare |
$432.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$415.15
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Humana Medicare |
$393.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.30
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.30
|
| Rate for Payer: University Health Alliance Commercial |
$139.55
|
|
|
HCHG IMMUNO EA ADDL SNGL
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
H3120327
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$371.45 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
|
|
HCHG IMMUNOGLOBULIN A
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3010778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$63.90
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$70.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.30
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$63.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
HCHG IMMUNOGLOBULIN A
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3010778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG IMMUNOGLOBULIN E
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
H3010782
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HCHG IMMUNOGLOBULIN E
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
H3010782
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.46
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$108.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$42.57
|
|
|
HCHG IMMUNOGLOBULIN G
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3010784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG IMMUNOGLOBULIN G
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3010784
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$63.90
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$70.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.30
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$63.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
HCHG IMMUNOGLOBULIN M
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3010786
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG IMMUNOGLOBULIN M
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
H3010786
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$63.90
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$70.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.30
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$63.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
HCHG IMMUNOGLOBULIN SUBCLASS
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
H3011398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
|
|
HCHG IMMUNOGLOBULIN SUBCLASS
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
H3011398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$61.38 |
| Rate for Payer: AlohaCare Medicaid |
$31.00
|
| Rate for Payer: AlohaCare Medicare |
$55.80
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Devoted Health Medicare |
$61.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Humana Medicare |
$55.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.80
|
| Rate for Payer: University Health Alliance Commercial |
$20.72
|
|
|
HCHG INCAL BX SKN SINGLE LES
|
Facility
|
OP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
H4501163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,593.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,310.00
|
| Rate for Payer: AlohaCare Medicare |
$2,358.00
|
| Rate for Payer: Cash Price |
$1,703.00
|
| Rate for Payer: Cash Price |
$1,703.00
|
| Rate for Payer: Devoted Health Medicare |
$2,593.80
|
| 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 |
$2,358.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,489.00
|
| Rate for Payer: Health Management Network Commercial |
$2,227.00
|
| Rate for Payer: Humana Medicare |
$2,358.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,358.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,541.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,358.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,358.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,358.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,909.72
|
|
|
HCHG INCAL BX SKN SINGLE LES
|
Facility
|
IP
|
$2,620.00
|
|
|
Service Code
|
HCPCS 11106
|
| Hospital Charge Code |
H4501163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,227.00 |
| Max. Negotiated Rate |
$2,541.40 |
| Rate for Payer: Cash Price |
$1,703.00
|
| Rate for Payer: Health Management Network Commercial |
$2,227.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,358.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,541.40
|
|
|
HCHG INCISION OF RECTAL ABSCESS
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
H4500981
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,451.00 |
| Max. Negotiated Rate |
$3,938.20 |
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Health Management Network Commercial |
$3,451.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,654.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,938.20
|
|
|
HCHG INCISION OF RECTAL ABSCESS
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
H4500981
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$2,030.00
|
| Rate for Payer: AlohaCare Medicare |
$3,654.00
|
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Cash Price |
$2,639.00
|
| Rate for Payer: Devoted Health Medicare |
$4,019.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,654.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,857.00
|
| Rate for Payer: Health Management Network Commercial |
$3,451.00
|
| Rate for Payer: Humana Medicare |
$3,654.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,654.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,654.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,938.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,654.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,654.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,654.00
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HCHG INCISION THROMBOSED HEMORRHOID
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
H4500498
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$705.00
|
| Rate for Payer: AlohaCare Medicare |
$1,269.00
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$1,395.90
|
| 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 |
$1,269.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,339.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Humana Medicare |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,269.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,269.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,269.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,027.75
|
|
|
HCHG INCISION THROMBOSED HEMORRHOID
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
H4500498
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,198.50 |
| Max. Negotiated Rate |
$1,367.70 |
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
|
|
HCHG INDIRECT COOMBS
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 86885
|
| Hospital Charge Code |
H3020610
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
|
