|
HCHG BONE MARROW;BX NDL/TROCAR
|
Facility
|
OP
|
$2,918.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
H3610459
|
|
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
|
|
|
HCHG BONE MARROW;BX NDL/TROCAR
|
Facility
|
IP
|
$2,918.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
H3610459
|
|
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 MULT
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
H3410198
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,354.05 |
| Max. Negotiated Rate |
$1,545.21 |
| Rate for Payer: Cash Price |
$1,035.45
|
| Rate for Payer: Health Management Network Commercial |
$1,354.05
|
| Rate for Payer: MDX Hawaii PPO |
$1,545.21
|
|
|
HCHG BONE MULT
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
HCPCS 78305
|
| Hospital Charge Code |
H3410198
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$1,545.21 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,035.45
|
| Rate for Payer: Cash Price |
$1,035.45
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$120.66
|
| 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 |
$131.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,354.05
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,003.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$812.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,545.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$120.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$440.60
|
|
|
HCHG BONE THREE PHASE
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
H3410134
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$2,188.32 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$157.41
|
| 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 |
$171.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,917.60
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,421.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,150.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,188.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$157.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$596.94
|
|
|
HCHG BONE THREE PHASE
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 78315
|
| Hospital Charge Code |
H3410134
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,917.60 |
| Max. Negotiated Rate |
$2,188.32 |
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Health Management Network Commercial |
$1,917.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,188.32
|
|
|
HCHG BONE WHOLE BODY
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
H3410136
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.75 |
| Max. Negotiated Rate |
$2,188.32 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$140.75
|
| 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 |
$152.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,917.60
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,421.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,150.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,188.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$493.12
|
|
|
HCHG BONE WHOLE BODY
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 78306
|
| Hospital Charge Code |
H3410136
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,917.60 |
| Max. Negotiated Rate |
$2,188.32 |
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Health Management Network Commercial |
$1,917.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,188.32
|
|
|
HCHG BRAF V600E MUTATATION DECTECTION - 90
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 81210
|
| Hospital Charge Code |
H3100208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$1,008.80 |
| Rate for Payer: AlohaCare Medicaid |
$175.40
|
| Rate for Payer: AlohaCare Medicare |
$175.40
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Devoted Health Medicare |
$192.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$175.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$219.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$175.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.40
|
| Rate for Payer: Health Management Network Commercial |
$884.00
|
| Rate for Payer: Humana Medicare |
$175.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$655.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$530.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,008.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.40
|
| Rate for Payer: University Health Alliance Commercial |
$758.06
|
|
|
HCHG BRAF V600E MUTATATION DECTECTION - 90
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 81210
|
| Hospital Charge Code |
H3100208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$884.00 |
| Max. Negotiated Rate |
$1,008.80 |
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Health Management Network Commercial |
$884.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,008.80
|
|
|
HCHG BRAIN NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
H3010290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
|
|
HCHG BRAIN NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
H3010290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: AlohaCare Medicaid |
$39.26
|
| Rate for Payer: AlohaCare Medicare |
$39.26
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Devoted Health Medicare |
$43.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Humana Medicare |
$39.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.26
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.26
|
| Rate for Payer: University Health Alliance Commercial |
$87.75
|
|
|
HCHG BRAIN W VASC FLOW, MIN 4 VIEWS
|
Facility
|
OP
|
$2,456.00
|
|
|
Service Code
|
HCPCS 78606
|
| Hospital Charge Code |
H3410144
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$127.46 |
| Max. Negotiated Rate |
$2,382.32 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,596.40
|
| Rate for Payer: Cash Price |
$1,596.40
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,087.60
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,547.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,252.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,382.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$557.29
|
|
|
HCHG BRAIN W VASC FLOW, MIN 4 VIEWS
|
Facility
|
IP
|
$2,456.00
|
|
|
Service Code
|
HCPCS 78606
|
| Hospital Charge Code |
H3410144
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,087.60 |
| Max. Negotiated Rate |
$2,382.32 |
| Rate for Payer: Cash Price |
$1,596.40
|
| Rate for Payer: Health Management Network Commercial |
$2,087.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,382.32
|
|
|
HCHG BREAST TOMOSYNTHESIS BI
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 77062
|
| Hospital Charge Code |
H4010133
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$291.97 |
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: MDX Hawaii PPO |
$291.97
|
|
|
HCHG BREAST TOMOSYNTHESIS BI
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 77062
|
| Hospital Charge Code |
H4010133
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$153.51 |
| Max. Negotiated Rate |
$291.97 |
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$285.95
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$189.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.51
|
| Rate for Payer: MDX Hawaii PPO |
$291.97
|
| Rate for Payer: University Health Alliance Commercial |
$219.40
|
|
|
HCHG BRONCHOSPASM
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
H4600104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$595.58 |
| Rate for Payer: AlohaCare Medicaid |
$440.83
|
| Rate for Payer: AlohaCare Medicare |
$440.83
|
| Rate for Payer: Cash Price |
$399.10
|
| Rate for Payer: Cash Price |
$399.10
|
| Rate for Payer: Devoted Health Medicare |
$484.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$551.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$440.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$583.30
|
| Rate for Payer: Health Management Network Commercial |
$521.90
|
| Rate for Payer: Humana Medicare |
$440.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$386.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$440.83
|
| Rate for Payer: MDX Hawaii PPO |
$595.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$440.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$440.83
|
| Rate for Payer: University Health Alliance Commercial |
$447.54
|
|
|
HCHG BRONCHOSPASM
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
H4600104
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$521.90 |
| Max. Negotiated Rate |
$595.58 |
| Rate for Payer: Cash Price |
$399.10
|
| Rate for Payer: Health Management Network Commercial |
$521.90
|
| Rate for Payer: MDX Hawaii PPO |
$595.58
|
|
|
HCHG BRUCELLA ABORTUS
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
H3020346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.93
|
| Rate for Payer: AlohaCare Medicare |
$8.93
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$9.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.93
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.93
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.93
|
| Rate for Payer: University Health Alliance Commercial |
$23.09
|
|
|
HCHG BRUCELLA ABORTUS
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
H3020346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG BURN INIT TREAT 1ST DEGREE
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
H4500146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$237.02
|
| Rate for Payer: AlohaCare Medicare |
$237.02
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$260.72
|
| 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 |
$237.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,171.35
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.02
|
| Rate for Payer: University Health Alliance Commercial |
$898.73
|
|
|
HCHG BURN INIT TREAT 1ST DEGREE
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
H4500146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG BURN WO ANESTH LG
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
H4500148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG BURN WO ANESTH LG
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
H4500148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.23 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,414.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$1,637.11
|
|
|
HCHG BURN WO ANESTH MED
|
Facility
|
OP
|
$1,098.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
H4500150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$237.02
|
| Rate for Payer: AlohaCare Medicare |
$237.02
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Devoted Health Medicare |
$260.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,043.10
|
| Rate for Payer: Health Management Network Commercial |
$933.30
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$691.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,065.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.02
|
| Rate for Payer: University Health Alliance Commercial |
$800.33
|
|
