|
HCHG KNEE 3 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
H3200520
|
|
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 KNEE BILAT STANDING
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
H3200518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| 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 |
$16.41
|
| 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 |
$17.57
|
| 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 |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$60.18
|
|
|
HCHG KNEE BILAT STANDING
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73565
|
| Hospital Charge Code |
H3200518
|
|
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 KNEE NOTCH 1-2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200524
|
|
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 KNEE NOTCH 1-2 VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200524
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$507.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$558.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$507.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
HCHG KNEE W OBLIQUES 4>VIEWS
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
H3200526
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$697.95 |
| Rate for Payer: AlohaCare Medicaid |
$352.50
|
| Rate for Payer: AlohaCare Medicare |
$634.50
|
| Rate for Payer: Cash Price |
$458.25
|
| Rate for Payer: Cash Price |
$458.25
|
| Rate for Payer: Devoted Health Medicare |
$697.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$634.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$599.25
|
| Rate for Payer: Humana Medicare |
$634.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$634.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$359.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$634.50
|
| Rate for Payer: MDX Hawaii PPO |
$683.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$634.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$634.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$634.50
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
HCHG KNEE W OBLIQUES 4>VIEWS
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
H3200526
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$599.25 |
| Max. Negotiated Rate |
$683.85 |
| Rate for Payer: Cash Price |
$458.25
|
| Rate for Payer: Health Management Network Commercial |
$599.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$634.50
|
| Rate for Payer: MDX Hawaii PPO |
$683.85
|
|
|
HCHG KUB AP 1 VW
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200528
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$499.95 |
| Rate for Payer: AlohaCare Medicaid |
$252.50
|
| Rate for Payer: AlohaCare Medicare |
$454.50
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Devoted Health Medicare |
$499.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Humana Medicare |
$454.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$454.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG KUB AP 1 VW
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200528
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
|
|
HCHG KUB PORT AP 1 VW
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200532
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$499.95 |
| Rate for Payer: AlohaCare Medicaid |
$252.50
|
| Rate for Payer: AlohaCare Medicare |
$454.50
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Devoted Health Medicare |
$499.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$454.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Humana Medicare |
$454.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$454.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$454.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$454.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG KUB PORT AP 1 VW
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200532
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$429.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$454.50
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
|
|
HCHG LACOSAMIDE
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
HCPCS 80235
|
| Hospital Charge Code |
H3011663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$230.35 |
| Max. Negotiated Rate |
$262.87 |
| Rate for Payer: Cash Price |
$176.15
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.90
|
| Rate for Payer: MDX Hawaii PPO |
$262.87
|
|
|
HCHG LACOSAMIDE
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS 80235
|
| Hospital Charge Code |
H3011663
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$268.29 |
| Rate for Payer: AlohaCare Medicaid |
$135.50
|
| Rate for Payer: AlohaCare Medicare |
$243.90
|
| Rate for Payer: Cash Price |
$176.15
|
| Rate for Payer: Cash Price |
$176.15
|
| Rate for Payer: Devoted Health Medicare |
$268.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.11
|
| Rate for Payer: Health Management Network Commercial |
$230.35
|
| Rate for Payer: Humana Medicare |
$243.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$243.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.90
|
| Rate for Payer: MDX Hawaii PPO |
$262.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.90
|
| Rate for Payer: University Health Alliance Commercial |
$197.53
|
|
|
HCHG LACTIC ACID
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
H3010808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG LACTIC ACID
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
H3010808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.60
|
|
|
HCHG LACTOFERRIN FECAL (QUAL) - 90
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 83630
|
| Hospital Charge Code |
H3011672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.25 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
|
|
HCHG LACTOFERRIN FECAL (QUAL) - 90
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 83630
|
| Hospital Charge Code |
H3011672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$143.55 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$130.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$143.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.70
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$130.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.73
|
|
|
HCHG LAMBDA LT CHAINS QUANT SERUM
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$102.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.15
|
|
|
HCHG LAMBDA LT CHAINS QUANT SERUM
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HCHG LAMBDA LT CHAINS QUANT U
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011336
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HCHG LAMBDA LT CHAINS QUANT U
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011336
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$102.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.15
|
|
|
HCHG LAMOTRIGNINE
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
H3011341
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: AlohaCare Medicaid |
$102.00
|
| Rate for Payer: AlohaCare Medicare |
$183.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Devoted Health Medicare |
$201.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Humana Medicare |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.60
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.60
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG LAMOTRIGNINE
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
H3011341
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
|
|
HCHG LARYNGOSCOPY DIR DIAG EX NB
|
Facility
|
IP
|
$5,243.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
H4500554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,456.55 |
| Max. Negotiated Rate |
$5,085.71 |
| Rate for Payer: Cash Price |
$3,407.95
|
| Rate for Payer: Health Management Network Commercial |
$4,456.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,718.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,085.71
|
|
|
HCHG LARYNGOSCOPY DIR DIAG EX NB
|
Facility
|
OP
|
$5,243.00
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
H4500554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,190.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,621.50
|
| Rate for Payer: AlohaCare Medicare |
$4,718.70
|
| Rate for Payer: Cash Price |
$3,407.95
|
| Rate for Payer: Cash Price |
$3,407.95
|
| Rate for Payer: Devoted Health Medicare |
$5,190.57
|
| 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 |
$4,718.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,980.85
|
| Rate for Payer: Health Management Network Commercial |
$4,456.55
|
| Rate for Payer: Humana Medicare |
$4,718.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,718.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,718.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,085.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,718.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,718.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,718.70
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
