|
HCHG AB COXIELLA BRUNETII EA
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020106
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$12.12
|
| Rate for Payer: AlohaCare Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.12
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.12
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
HCHG AB COXIELLA BRUNETII EA
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$12.12
|
| Rate for Payer: AlohaCare Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.12
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.12
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
HCHG AB COXIELLA BRUNETII EA
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG AB COXIELLA BRUNETTI EA
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG AB COXIELLA BRUNETTI EA
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86638
|
| Hospital Charge Code |
H3020108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$12.12
|
| Rate for Payer: AlohaCare Medicare |
$12.12
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.12
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$12.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.12
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.12
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
HCHG ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$612.07 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$612.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
HCHG ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$612.07 |
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: MDX Hawaii PPO |
$612.07
|
|
|
HCHG ABDOMEN 2 VIEWS PORT
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$612.07 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$397.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$612.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$68.82
|
|
|
HCHG ABDOMEN 2 VIEWS PORT
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
H3200116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$612.07 |
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: MDX Hawaii PPO |
$612.07
|
|
|
HCHG ABDOMEN 3 VIEWS OR MORE
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
H3200999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG ABDOMEN 3 VIEWS OR MORE
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 74021
|
| Hospital Charge Code |
H3200999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$80.29
|
|
|
HCHG ABDOMEN AP 1 VIEW
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$413.22 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$362.10
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$217.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$413.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG ABDOMEN AP 1 VIEW
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$413.22 |
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Health Management Network Commercial |
$362.10
|
| Rate for Payer: MDX Hawaii PPO |
$413.22
|
|
|
HCHG ABDOMEN-CROSS TABLE LAT-PORT AP 1 VW
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$413.22 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$362.10
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$217.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$413.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG ABDOMEN-CROSS TABLE LAT-PORT AP 1 VW
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$413.22 |
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Health Management Network Commercial |
$362.10
|
| Rate for Payer: MDX Hawaii PPO |
$413.22
|
|
|
HCHG ABDOMEN DECUBITUS AP 1 VIEW
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$413.22 |
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Health Management Network Commercial |
$362.10
|
| Rate for Payer: MDX Hawaii PPO |
$413.22
|
|
|
HCHG ABDOMEN DECUBITUS AP 1 VIEW
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
HCPCS 74018
|
| Hospital Charge Code |
H3200112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$413.22 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$362.10
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$268.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$217.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$413.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.31
|
|
|
HCHG ABDOMEN MRI W CONTR
|
Facility
|
IP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
H6100104
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,921.85 |
| Max. Negotiated Rate |
$2,193.17 |
| Rate for Payer: Cash Price |
$1,469.65
|
| Rate for Payer: Health Management Network Commercial |
$1,921.85
|
| Rate for Payer: MDX Hawaii PPO |
$2,193.17
|
|
|
HCHG ABDOMEN MRI W CONTR
|
Facility
|
OP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 74182
|
| Hospital Charge Code |
H6100104
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$383.16 |
| Max. Negotiated Rate |
$2,193.17 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$1,469.65
|
| Rate for Payer: Cash Price |
$1,469.65
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$383.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$476.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,921.85
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,424.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,153.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$2,193.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$383.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$984.01
|
|
|
HCHG ABDOMEN MRI WO CONTR
|
Facility
|
IP
|
$2,180.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
H6100106
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,853.00 |
| Max. Negotiated Rate |
$2,114.60 |
| Rate for Payer: Cash Price |
$1,417.00
|
| Rate for Payer: Health Management Network Commercial |
$1,853.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,114.60
|
|
|
HCHG ABDOMEN MRI WO CONTR
|
Facility
|
OP
|
$2,180.00
|
|
|
Service Code
|
HCPCS 74181
|
| Hospital Charge Code |
H6100106
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$2,114.60 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$1,417.00
|
| Rate for Payer: Cash Price |
$1,417.00
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$369.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$395.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$1,853.00
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,373.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,111.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$2,114.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$369.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$846.89
|
|
|
HCHG ABDOMEN MRI W/WO CONTR
|
Facility
|
IP
|
$3,102.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
H6100102
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,636.70 |
| Max. Negotiated Rate |
$3,008.94 |
| Rate for Payer: Cash Price |
$2,016.30
|
| Rate for Payer: Health Management Network Commercial |
$2,636.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,008.94
|
|
|
HCHG ABDOMEN MRI W/WO CONTR
|
Facility
|
OP
|
$3,102.00
|
|
|
Service Code
|
HCPCS 74183
|
| Hospital Charge Code |
H6100102
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$3,008.94 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$2,016.30
|
| Rate for Payer: Cash Price |
$2,016.30
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$709.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$882.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$2,636.70
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,954.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,582.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$3,008.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$709.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,294.91
|
|
|
HCHG ABD PARACENTESIS DIAG/THERP;W/O IMG GUID
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
H4501045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG ABD PARACENTESIS DIAG/THERP;W/O IMG GUID
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
H4501045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.46
|
| Rate for Payer: AlohaCare Medicare |
$1,071.46
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$1,178.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,071.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$1,071.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,857.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.46
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,178.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.46
|
| Rate for Payer: University Health Alliance Commercial |
$3,305.56
|
|
