|
HCHG BURN WO ANESTH MED
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
H4500150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$933.30 |
| Max. Negotiated Rate |
$1,065.06 |
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Health Management Network Commercial |
$933.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,065.06
|
|
|
HCHG BURN WO ANESTH SML
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
H4500152
|
|
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 SML
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 16020
|
| Hospital Charge Code |
H4500152
|
|
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 BX BONE DEEP
|
Facility
|
OP
|
$3,186.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
H3610128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Health Management Network Commercial |
$2,708.10
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,007.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$3,090.42
|
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG BX BONE DEEP
|
Facility
|
IP
|
$3,186.00
|
|
|
Service Code
|
HCPCS 20225
|
| Hospital Charge Code |
H3610128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,708.10 |
| Max. Negotiated Rate |
$3,090.42 |
| Rate for Payer: Cash Price |
$2,070.90
|
| Rate for Payer: Health Management Network Commercial |
$2,708.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,090.42
|
|
|
HCHG BX LIVER NDL
|
Facility
|
IP
|
$3,673.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
H4020104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,122.05 |
| Max. Negotiated Rate |
$3,562.81 |
| Rate for Payer: Cash Price |
$2,387.45
|
| Rate for Payer: Health Management Network Commercial |
$3,122.05
|
| Rate for Payer: MDX Hawaii PPO |
$3,562.81
|
|
|
HCHG BX LIVER NDL
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
HCPCS 47000
|
| Hospital Charge Code |
H4020104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$3,562.81 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$2,387.45
|
| Rate for Payer: Cash Price |
$2,387.45
|
| Rate for Payer: Cash Price |
$2,387.45
|
| 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 |
$3,122.05
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,313.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$3,562.81
|
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$2,677.25
|
|
|
HCHG BX MUSCLE PERC NDL
|
Facility
|
OP
|
$3,687.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
H3610138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$2,396.55
|
| Rate for Payer: Cash Price |
$2,396.55
|
| Rate for Payer: Cash Price |
$2,396.55
|
| 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 |
$3,133.95
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,322.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$3,576.39
|
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG BX MUSCLE PERC NDL
|
Facility
|
IP
|
$3,687.00
|
|
|
Service Code
|
HCPCS 20206
|
| Hospital Charge Code |
H3610138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,133.95 |
| Max. Negotiated Rate |
$3,576.39 |
| Rate for Payer: Cash Price |
$2,396.55
|
| Rate for Payer: Health Management Network Commercial |
$3,133.95
|
| Rate for Payer: MDX Hawaii PPO |
$3,576.39
|
|
|
HCHG C1 ESTERASE INHIBITOR ACTIV 90
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
H3020350
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HCHG C1 ESTERASE INHIBITOR ACTIV 90
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
H3020350
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
HCHG C1 ESTERASE INHIBITOR, PROTEIN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3021025
|
|
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 C1 ESTERASE INHIBITOR, PROTEIN
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
H3021025
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HCHG CA 125
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
H3020356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$248.32 |
| Rate for Payer: AlohaCare Medicaid |
$20.81
|
| Rate for Payer: AlohaCare Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Devoted Health Medicare |
$22.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.81
|
| Rate for Payer: MDX Hawaii PPO |
$248.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 125
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
H3020356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$248.32 |
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: MDX Hawaii PPO |
$248.32
|
|
|
HCHG CA 15-3 90
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020358
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: AlohaCare Medicaid |
$20.81
|
| Rate for Payer: AlohaCare Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Devoted Health Medicare |
$22.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.81
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 15-3 90
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020358
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
|
|
HCHG CA 19-9 90
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
H3020360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$273.54 |
| Rate for Payer: AlohaCare Medicaid |
$20.81
|
| Rate for Payer: AlohaCare Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Devoted Health Medicare |
$22.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$239.70
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.81
|
| Rate for Payer: MDX Hawaii PPO |
$273.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 19-9 90
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
H3020360
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$239.70 |
| Max. Negotiated Rate |
$273.54 |
| Rate for Payer: Cash Price |
$183.30
|
| Rate for Payer: Health Management Network Commercial |
$239.70
|
| Rate for Payer: MDX Hawaii PPO |
$273.54
|
|
|
HCHG CA 27.29 BIOMIRA 90
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: AlohaCare Medicaid |
$20.81
|
| Rate for Payer: AlohaCare Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Devoted Health Medicare |
$22.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.81
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CA 27.29 BIOMIRA 90
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
H3020362
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Health Management Network Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$261.90
|
|
|
HCHG CADMIUM 90
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
H3010298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
|
|
HCHG CADMIUM 90
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
H3010298
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: AlohaCare Medicaid |
$23.64
|
| Rate for Payer: AlohaCare Medicare |
$23.64
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Devoted Health Medicare |
$26.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.64
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Humana Medicare |
$23.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.64
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.64
|
| Rate for Payer: University Health Alliance Commercial |
$59.81
|
|
|
HCHG CALCITONIN 90
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
H3010304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$293.25 |
| Max. Negotiated Rate |
$334.65 |
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Health Management Network Commercial |
$293.25
|
| Rate for Payer: MDX Hawaii PPO |
$334.65
|
|
|
HCHG CALCITONIN 90
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
H3010304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$334.65 |
| Rate for Payer: AlohaCare Medicaid |
$26.79
|
| Rate for Payer: AlohaCare Medicare |
$26.79
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Devoted Health Medicare |
$29.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.79
|
| Rate for Payer: Health Management Network Commercial |
$293.25
|
| Rate for Payer: Humana Medicare |
$26.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.79
|
| Rate for Payer: MDX Hawaii PPO |
$334.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.79
|
| Rate for Payer: University Health Alliance Commercial |
$69.21
|
|
