|
HCHG INSERT PICC WO PORT/PUMP 5YR>
|
Facility
|
OP
|
$3,598.00
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
H4500532
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,562.02 |
| Rate for Payer: AlohaCare Medicaid |
$1,799.00
|
| Rate for Payer: AlohaCare Medicare |
$3,238.20
|
| Rate for Payer: Cash Price |
$2,338.70
|
| Rate for Payer: Cash Price |
$2,338.70
|
| Rate for Payer: Devoted Health Medicare |
$3,562.02
|
| 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 |
$3,238.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,418.10
|
| Rate for Payer: Health Management Network Commercial |
$3,058.30
|
| Rate for Payer: Humana Medicare |
$3,238.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,238.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,238.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,490.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,238.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,238.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,238.20
|
| Rate for Payer: University Health Alliance Commercial |
$2,622.58
|
|
|
HCHG INSERT THORACOSTOMY TUBE OPEN
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
H4501058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,831.20 |
| Rate for Payer: AlohaCare Medicaid |
$2,440.00
|
| Rate for Payer: AlohaCare Medicare |
$4,392.00
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Devoted Health Medicare |
$4,831.20
|
| 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 |
$4,392.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,636.00
|
| Rate for Payer: Health Management Network Commercial |
$4,148.00
|
| Rate for Payer: Humana Medicare |
$4,392.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,392.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,392.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,733.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,392.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,392.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,392.00
|
| Rate for Payer: University Health Alliance Commercial |
$3,557.03
|
|
|
HCHG INSERT THORACOSTOMY TUBE OPEN
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
H4501058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,148.00 |
| Max. Negotiated Rate |
$4,733.60 |
| Rate for Payer: Cash Price |
$3,172.00
|
| Rate for Payer: Health Management Network Commercial |
$4,148.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,392.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,733.60
|
|
|
HCHG INS TUNNELED CVAD WO PORT/PUMP >5Y
|
Facility
|
IP
|
$6,985.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
H4501053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,937.25 |
| Max. Negotiated Rate |
$6,775.45 |
| Rate for Payer: Cash Price |
$4,540.25
|
| Rate for Payer: Health Management Network Commercial |
$5,937.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,286.50
|
| Rate for Payer: MDX Hawaii PPO |
$6,775.45
|
|
|
HCHG INS TUNNELED CVAD WO PORT/PUMP >5Y
|
Facility
|
OP
|
$6,985.00
|
|
|
Service Code
|
HCPCS 36558
|
| Hospital Charge Code |
H4501053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,915.15 |
| Rate for Payer: AlohaCare Medicaid |
$3,492.50
|
| Rate for Payer: AlohaCare Medicare |
$6,286.50
|
| Rate for Payer: Cash Price |
$4,540.25
|
| Rate for Payer: Cash Price |
$4,540.25
|
| Rate for Payer: Devoted Health Medicare |
$6,915.15
|
| 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 |
$6,286.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,635.75
|
| Rate for Payer: Health Management Network Commercial |
$5,937.25
|
| Rate for Payer: Humana Medicare |
$6,286.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,286.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,286.50
|
| Rate for Payer: MDX Hawaii PPO |
$6,775.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,286.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,286.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,286.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG INSULIN AUTOANTIBODY
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
H3021000
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: AlohaCare Medicaid |
$77.50
|
| Rate for Payer: AlohaCare Medicare |
$139.50
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Devoted Health Medicare |
$153.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.41
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Humana Medicare |
$139.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.50
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.35
|
|
|
HCHG INSULIN AUTOANTIBODY
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 86337
|
| Hospital Charge Code |
H3021000
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
|
|
HCHG INSULIN TOTAL 90
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
H3010788
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HCHG INSULIN TOTAL 90
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 83525
|
| Hospital Charge Code |
H3010788
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$78.30
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Devoted Health Medicare |
$86.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.43
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$78.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.30
|
| Rate for Payer: University Health Alliance Commercial |
$29.56
|
|
|
HCHG INTERPHASE INSITU HYBRID, ANALYZE 90
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
H3110287
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$323.01 |
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.70
|
| Rate for Payer: MDX Hawaii PPO |
$323.01
|
|
|
HCHG INTERPHASE INSITU HYBRID, ANALYZE 90
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
H3110287
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$329.67 |
| Rate for Payer: AlohaCare Medicaid |
$166.50
|
| Rate for Payer: AlohaCare Medicare |
$299.70
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Devoted Health Medicare |
$329.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$299.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.19
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Humana Medicare |
$299.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$299.70
|
| Rate for Payer: MDX Hawaii PPO |
$323.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$299.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$299.70
|
| Rate for Payer: University Health Alliance Commercial |
$103.80
|
|
|
HCHG INTRAORAL I&D TONGUE/MOUTH FLR
|
Facility
|
IP
|
$2,569.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
H4500540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,183.65 |
| Max. Negotiated Rate |
$2,491.93 |
| Rate for Payer: Cash Price |
$1,669.85
|
| Rate for Payer: Health Management Network Commercial |
$2,183.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,312.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,491.93
|
|
|
HCHG INTRAORAL I&D TONGUE/MOUTH FLR
|
Facility
|
OP
|
$2,569.00
|
|
|
Service Code
|
HCPCS 41000
|
| Hospital Charge Code |
H4500540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,543.31 |
| Rate for Payer: AlohaCare Medicaid |
$1,284.50
|
| Rate for Payer: AlohaCare Medicare |
$2,312.10
|
| Rate for Payer: Cash Price |
$1,669.85
|
| Rate for Payer: Cash Price |
$1,669.85
|
| Rate for Payer: Devoted Health Medicare |
$2,543.31
|
| 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 |
$2,312.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,440.55
|
| Rate for Payer: Health Management Network Commercial |
$2,183.65
|
| Rate for Payer: Humana Medicare |
$2,312.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,312.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,312.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,491.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,312.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,312.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,312.10
|
| Rate for Payer: University Health Alliance Commercial |
$1,872.54
|
|
|
HCHG INTUBATION ENDOTRACHEAL (EMERGENCY)
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
H4500542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$762.00
|
| Rate for Payer: AlohaCare Medicare |
$1,371.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Devoted Health Medicare |
$1,508.76
|
| 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 |
$1,371.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,447.80
|
| Rate for Payer: Health Management Network Commercial |
$1,295.40
|
| Rate for Payer: Humana Medicare |
$1,371.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,371.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,371.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,478.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,371.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,371.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,371.60
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG INTUBATION ENDOTRACHEAL (EMERGENCY)
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
H4500542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,295.40 |
| Max. Negotiated Rate |
$1,478.28 |
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Health Management Network Commercial |
$1,295.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,371.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,478.28
|
|
|
HCHG I&R FB SIMP
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
H4500490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| 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 |
$5,160.40
|
|
|
HCHG I&R FB SIMP
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
H4500490
|
|
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 IRON BINDING
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
H3010794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.85 |
| Max. Negotiated Rate |
$156.17 |
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
|
|
HCHG IRON BINDING
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
H3010794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$159.39 |
| Rate for Payer: AlohaCare Medicaid |
$80.50
|
| Rate for Payer: AlohaCare Medicare |
$144.90
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Devoted Health Medicare |
$159.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.74
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Humana Medicare |
$144.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.90
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.90
|
| Rate for Payer: University Health Alliance Commercial |
$22.59
|
|
|
HCHG IRON TOT
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
H3010800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$97.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Devoted Health Medicare |
$106.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$97.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.20
|
| Rate for Payer: University Health Alliance Commercial |
$16.74
|
|
|
HCHG IRON TOT
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
H3010800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HCHG IRRIG CORPORA CAVERNOSA PRIAP
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
H4500544
|
|
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 IRRIG CORPORA CAVERNOSA PRIAP
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
H4500544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,743.44 |
| 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 |
$6,743.44
|
|
|
HCHG ISITU MORPH MANUAL
|
Facility
|
OP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 88368
|
| Hospital Charge Code |
H3120316
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$1,581.03 |
| Rate for Payer: AlohaCare Medicaid |
$798.50
|
| Rate for Payer: AlohaCare Medicare |
$1,437.30
|
| Rate for Payer: Cash Price |
$1,038.05
|
| Rate for Payer: Cash Price |
$1,038.05
|
| Rate for Payer: Devoted Health Medicare |
$1,581.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,437.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$1,357.45
|
| Rate for Payer: Humana Medicare |
$1,437.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,437.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$814.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,437.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,549.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,437.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,437.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,437.30
|
| Rate for Payer: University Health Alliance Commercial |
$388.52
|
|
|
HCHG ISITU MORPH MANUAL
|
Facility
|
IP
|
$1,597.00
|
|
|
Service Code
|
HCPCS 88368
|
| Hospital Charge Code |
H3120316
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,357.45 |
| Max. Negotiated Rate |
$1,549.09 |
| Rate for Payer: Cash Price |
$1,038.05
|
| Rate for Payer: Health Management Network Commercial |
$1,357.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,437.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,549.09
|
|
