|
HCHG ANTI-GLOM BASEMT MEM AB 90
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3010236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: AlohaCare Medicaid |
$17.27
|
| Rate for Payer: AlohaCare Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$19.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.27
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.27
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG ANTI-HISTONE AB 90
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3020256
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HCHG ANTI-HISTONE AB 90
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3020256
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG ANTI-NUCLEAR AB
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: AlohaCare Medicaid |
$12.09
|
| Rate for Payer: AlohaCare Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Devoted Health Medicare |
$13.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: Humana Medicare |
$12.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.09
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.09
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HCHG ANTI-NUCLEAR AB
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
|
|
HCHG ANTISTREP O TITER
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
H3020278
|
|
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: MDX Hawaii PPO |
$88.27
|
|
|
HCHG ANTISTREP O TITER
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
H3020278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: AlohaCare Medicaid |
$7.30
|
| Rate for Payer: AlohaCare Medicare |
$7.30
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$8.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$7.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.30
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.30
|
| Rate for Payer: University Health Alliance Commercial |
$18.87
|
|
|
HCHG ANTI-STRIAT MUSC AB 90
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3020280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG ANTI-STRIAT MUSC AB 90
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3020280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
HCHG ANTI-THROMBIN III
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
H3050102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
HCHG ANTI-THROMBIN III
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
H3050102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: AlohaCare Medicaid |
$11.85
|
| Rate for Payer: AlohaCare Medicare |
$11.85
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$13.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.85
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$11.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.85
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.85
|
| Rate for Payer: University Health Alliance Commercial |
$30.62
|
|
|
HCHG ANTITHROMBIN III AG
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
K3050003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$150.45 |
| Max. Negotiated Rate |
$171.69 |
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: MDX Hawaii PPO |
$171.69
|
|
|
HCHG ANTITHROMBIN III AG
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
K3050003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$171.69 |
| Rate for Payer: AlohaCare Medicaid |
$10.81
|
| Rate for Payer: AlohaCare Medicare |
$10.81
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Cash Price |
$115.05
|
| Rate for Payer: Devoted Health Medicare |
$11.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.81
|
| Rate for Payer: Health Management Network Commercial |
$150.45
|
| Rate for Payer: Humana Medicare |
$10.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.81
|
| Rate for Payer: MDX Hawaii PPO |
$171.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.81
|
| Rate for Payer: University Health Alliance Commercial |
$27.95
|
|
|
HCHG ANTI-THYROGLOBULIN
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
H3020282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: AlohaCare Medicaid |
$15.91
|
| Rate for Payer: AlohaCare Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Devoted Health Medicare |
$17.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.91
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.91
|
| Rate for Payer: MDX Hawaii PPO |
$190.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.91
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
HCHG ANTI-THYROGLOBULIN
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
H3020282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: MDX Hawaii PPO |
$190.12
|
|
|
HCHG ANTI-TPO MICROSOMAL
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$14.55
|
| Rate for Payer: AlohaCare Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$16.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.55
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$14.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.55
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.55
|
| Rate for Payer: University Health Alliance Commercial |
$37.61
|
|
|
HCHG ANTI-TPO MICROSOMAL
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HCHG AP PELVIS 1-2 VIEWS
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
H3200168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
HCHG AP PELVIS 1-2 VIEWS
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
H3200168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| 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 |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.37
|
|
|
HCHG AP PELVIS PORT 1-2 VIEWS
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
H3200170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.74
|
| 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 |
$19.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$231.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.37
|
|
|
HCHG AP PELVIS PORT 1-2 VIEWS
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
H3200170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.90 |
| Max. Negotiated Rate |
$440.38 |
| Rate for Payer: Cash Price |
$295.10
|
| Rate for Payer: Health Management Network Commercial |
$385.90
|
| Rate for Payer: MDX Hawaii PPO |
$440.38
|
|
|
HCHG APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
H4500964
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$69.69
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$449.35
|
| Rate for Payer: Health Management Network Commercial |
$402.05
|
| Rate for Payer: Humana Medicare |
$69.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.69
|
| Rate for Payer: MDX Hawaii PPO |
$458.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
| Rate for Payer: University Health Alliance Commercial |
$344.77
|
|
|
HCHG APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
H4500964
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.05 |
| Max. Negotiated Rate |
$458.81 |
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Health Management Network Commercial |
$402.05
|
| Rate for Payer: MDX Hawaii PPO |
$458.81
|
|
|
HCHG APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
H4501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,335.35 |
| Max. Negotiated Rate |
$1,523.87 |
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Health Management Network Commercial |
$1,335.35
|
| Rate for Payer: MDX Hawaii PPO |
$1,523.87
|
|
|
HCHG APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
HCPCS 29425
|
| Hospital Charge Code |
H4501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.41 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$330.41
|
| Rate for Payer: AlohaCare Medicare |
$330.41
|
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Cash Price |
$1,021.15
|
| Rate for Payer: Devoted Health Medicare |
$363.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$330.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,492.45
|
| Rate for Payer: Health Management Network Commercial |
$1,335.35
|
| Rate for Payer: Humana Medicare |
$330.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$989.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.41
|
| Rate for Payer: MDX Hawaii PPO |
$1,523.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.41
|
| Rate for Payer: University Health Alliance Commercial |
$1,145.10
|
|
