|
HCHG BLOOD COUNT AUTO DIFF
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 85004
|
| Hospital Charge Code |
K3050001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: AlohaCare Medicaid |
$6.47
|
| Rate for Payer: AlohaCare Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$7.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.47
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.47
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HCHG BLOOD GAS CORD ART BLD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
K3010030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$467.54 |
| Rate for Payer: AlohaCare Medicaid |
$78.77
|
| Rate for Payer: AlohaCare Medicare |
$78.77
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Devoted Health Medicare |
$86.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.77
|
| Rate for Payer: MDX Hawaii PPO |
$467.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.77
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
HCHG BLOOD GAS CORD ART BLD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
K3010030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$409.70 |
| Max. Negotiated Rate |
$467.54 |
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: MDX Hawaii PPO |
$467.54
|
|
|
HCHG BLOOD GAS CORD VENOUS BL
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
K3010031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$409.70 |
| Max. Negotiated Rate |
$467.54 |
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: MDX Hawaii PPO |
$467.54
|
|
|
HCHG BLOOD GAS CORD VENOUS BL
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
K3010031
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$467.54 |
| Rate for Payer: AlohaCare Medicaid |
$78.77
|
| Rate for Payer: AlohaCare Medicare |
$78.77
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Devoted Health Medicare |
$86.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.77
|
| Rate for Payer: MDX Hawaii PPO |
$467.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.77
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
HCHG BLOOD GASES, CAPILLARY
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3011613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$324.95 |
| Rate for Payer: AlohaCare Medicaid |
$26.07
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$284.75
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$170.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.07
|
| Rate for Payer: MDX Hawaii PPO |
$324.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HCHG BLOOD GASES, CAPILLARY
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3011613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$324.95 |
| Rate for Payer: Cash Price |
$217.75
|
| Rate for Payer: Health Management Network Commercial |
$284.75
|
| Rate for Payer: MDX Hawaii PPO |
$324.95
|
|
|
HCHG BLOOD GAS W O2 SAT DIRECT
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
K3010029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$467.54 |
| Rate for Payer: AlohaCare Medicaid |
$78.77
|
| Rate for Payer: AlohaCare Medicare |
$78.77
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Devoted Health Medicare |
$86.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.77
|
| Rate for Payer: MDX Hawaii PPO |
$467.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.77
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
HCHG BLOOD GAS W O2 SAT DIRECT
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
K3010029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$409.70 |
| Max. Negotiated Rate |
$467.54 |
| Rate for Payer: Cash Price |
$313.30
|
| Rate for Payer: Health Management Network Commercial |
$409.70
|
| Rate for Payer: MDX Hawaii PPO |
$467.54
|
|
|
HCHG BLOOD TYPING ABO
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
H3020314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: AlohaCare Medicaid |
$2.99
|
| Rate for Payer: AlohaCare Medicare |
$2.99
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$3.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$2.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.99
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.99
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HCHG BLOOD TYPING ABO
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
H3020314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
|
|
HCHG BLOOD TYPING RH
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$2.99
|
| Rate for Payer: AlohaCare Medicare |
$2.99
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$3.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$2.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.99
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.99
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HCHG BLOOD TYPING RH
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020336
|
|
Hospital Revenue Code
|
302
|
| 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: MDX Hawaii PPO |
$140.65
|
|
|
HCHG BODY FLD CYTOLOGY
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
H3110108
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Cash Price |
$125.45
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
| Rate for Payer: MDX Hawaii PPO |
$187.21
|
|
|
HCHG BODY FLD CYTOLOGY
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 88104
|
| Hospital Charge Code |
H3110108
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: AlohaCare Medicaid |
$44.12
|
| Rate for Payer: AlohaCare Medicare |
$44.12
|
| Rate for Payer: Cash Price |
$125.45
|
| Rate for Payer: Cash Price |
$125.45
|
| Rate for Payer: Devoted Health Medicare |
$48.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.12
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
| Rate for Payer: Humana Medicare |
$44.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.12
|
| Rate for Payer: MDX Hawaii PPO |
$187.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.12
|
| Rate for Payer: University Health Alliance Commercial |
$118.33
|
|
|
HCHG BONE AGE
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
H3200218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$649.90 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.46
|
| 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 |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$569.50
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$341.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$649.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$47.17
|
|
|
HCHG BONE AGE
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
H3200218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$569.50 |
| Max. Negotiated Rate |
$649.90 |
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Health Management Network Commercial |
$569.50
|
| Rate for Payer: MDX Hawaii PPO |
$649.90
|
|
|
HCHG BONE LENGTH
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
H3200220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.30
|
| 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 |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$527.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$427.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$82.49
|
|
|
HCHG BONE LENGTH
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
H3200220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$544.70
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
|
HCHG BONE LTD
|
Facility
|
OP
|
$2,148.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
H3410120
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$2,083.56 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,396.20
|
| Rate for Payer: Cash Price |
$1,396.20
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$89.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,825.80
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,353.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,095.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,083.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$324.68
|
|
|
HCHG BONE LTD
|
Facility
|
IP
|
$2,148.00
|
|
|
Service Code
|
HCPCS 78300
|
| Hospital Charge Code |
H3410120
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,825.80 |
| Max. Negotiated Rate |
$2,083.56 |
| Rate for Payer: Cash Price |
$1,396.20
|
| Rate for Payer: Health Management Network Commercial |
$1,825.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,083.56
|
|
|
HCHG BONE MARROW ASP/EXAM
|
Facility
|
OP
|
$8,126.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
H3610122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$7,882.22 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$5,281.90
|
| Rate for Payer: Cash Price |
$5,281.90
|
| Rate for Payer: Cash Price |
$5,281.90
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$6,907.10
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,119.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$7,882.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.04
|
|
|
HCHG BONE MARROW ASP/EXAM
|
Facility
|
IP
|
$8,126.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
H3610122
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,907.10 |
| Max. Negotiated Rate |
$7,882.22 |
| Rate for Payer: Cash Price |
$5,281.90
|
| Rate for Payer: Health Management Network Commercial |
$6,907.10
|
| Rate for Payer: MDX Hawaii PPO |
$7,882.22
|
|
|
HCHG BONE MARROW BIOPSY NEEDLE/TROCAR
|
Facility
|
IP
|
$2,918.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
H3610576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,480.30 |
| Max. Negotiated Rate |
$2,830.46 |
| Rate for Payer: Cash Price |
$1,896.70
|
| Rate for Payer: Health Management Network Commercial |
$2,480.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,830.46
|
|
|
HCHG BONE MARROW BIOPSY NEEDLE/TROCAR
|
Facility
|
OP
|
$2,918.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
H3610576
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$1,896.70
|
| Rate for Payer: Cash Price |
$1,896.70
|
| Rate for Payer: Cash Price |
$1,896.70
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$2,480.30
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,838.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$2,830.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$2,126.93
|
|
