|
HCHG CHEMO ADMIN IV PUSH EA ADDL
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
H3310108
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$46.33 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: AlohaCare Medicaid |
$85.06
|
| Rate for Payer: AlohaCare Medicare |
$85.06
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Devoted Health Medicare |
$93.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$106.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$492.10
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Humana Medicare |
$85.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.06
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.06
|
| Rate for Payer: University Health Alliance Commercial |
$377.57
|
|
|
HCHG CHEMO ADMIN IV PUSH EA ADDL
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 96411
|
| Hospital Charge Code |
H3310108
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
|
|
HCHG CHEMO ADMIN IV PUSH INITIAL
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
H3310102
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$810.90 |
| Max. Negotiated Rate |
$925.38 |
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: MDX Hawaii PPO |
$925.38
|
|
|
HCHG CHEMO ADMIN IV PUSH INITIAL
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
HCPCS 96409
|
| Hospital Charge Code |
H3310102
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$925.38 |
| Rate for Payer: AlohaCare Medicaid |
$390.20
|
| Rate for Payer: AlohaCare Medicare |
$390.20
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Devoted Health Medicare |
$429.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$487.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$390.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$906.30
|
| Rate for Payer: Health Management Network Commercial |
$810.90
|
| Rate for Payer: Humana Medicare |
$390.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$601.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.20
|
| Rate for Payer: MDX Hawaii PPO |
$925.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$390.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$390.20
|
| Rate for Payer: University Health Alliance Commercial |
$695.37
|
|
|
HCHG CHEMO ADMIN SUBQ/IM
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
H3310104
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
|
|
HCHG CHEMO ADMIN SUBQ/IM
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 96401
|
| Hospital Charge Code |
H3310104
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.54 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: AlohaCare Medicaid |
$85.06
|
| Rate for Payer: AlohaCare Medicare |
$85.06
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Devoted Health Medicare |
$93.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$106.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$492.10
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Humana Medicare |
$85.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.06
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.06
|
| Rate for Payer: University Health Alliance Commercial |
$377.57
|
|
|
HCHG CHEMO INF PORT PUMP INITIAL
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
H3310110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$122.71 |
| Max. Negotiated Rate |
$1,794.50 |
| Rate for Payer: AlohaCare Medicaid |
$390.20
|
| Rate for Payer: AlohaCare Medicare |
$390.20
|
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Devoted Health Medicare |
$429.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$487.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$390.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,757.50
|
| Rate for Payer: Health Management Network Commercial |
$1,572.50
|
| Rate for Payer: Humana Medicare |
$390.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,165.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$943.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,794.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$390.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$390.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,348.46
|
|
|
HCHG CHEMO INF PORT PUMP INITIAL
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 96416
|
| Hospital Charge Code |
H3310110
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$1,572.50 |
| Max. Negotiated Rate |
$1,794.50 |
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Health Management Network Commercial |
$1,572.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,794.50
|
|
|
HCHG CHEST AP 1 VIEW
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240102
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$412.25 |
| Max. Negotiated Rate |
$470.45 |
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Health Management Network Commercial |
$412.25
|
| Rate for Payer: MDX Hawaii PPO |
$470.45
|
|
|
HCHG CHEST AP 1 VIEW
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240102
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$470.45 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| 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 |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$412.25
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$470.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HCHG CHEST AP ONLY PORT 1 VIEW
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240118
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$470.45 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| 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 |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$412.25
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$470.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
|
HCHG CHEST AP ONLY PORT 1 VIEW
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240118
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$412.25 |
| Max. Negotiated Rate |
$470.45 |
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Health Management Network Commercial |
$412.25
|
| Rate for Payer: MDX Hawaii PPO |
$470.45
|
|
|
HCHG CHEST INSP/EXP 2 VIEWS
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240108
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| 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 |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$359.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$552.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG CHEST INSP/EXP 2 VIEWS
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240108
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$484.50 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: MDX Hawaii PPO |
$552.90
|
|
|
HCHG CHEST MRI WO CONTR
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
H6100110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,654.10 |
| Max. Negotiated Rate |
$1,887.62 |
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Health Management Network Commercial |
$1,654.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,887.62
|
|
|
HCHG CHEST MRI WO CONTR
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS 71550
|
| Hospital Charge Code |
H6100110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$1,887.62 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Cash Price |
$1,264.90
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$369.93
|
| 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 |
$395.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$1,654.10
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,225.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$992.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$1,887.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$369.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$847.54
|
|
|
HCHG CHEST MRI W/WO CONTR
|
Facility
|
OP
|
$2,820.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
H6100108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$2,735.40 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$704.71
|
| 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 |
$877.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$2,397.00
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,776.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,438.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$2,735.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$704.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,300.64
|
|
|
HCHG CHEST MRI W/WO CONTR
|
Facility
|
IP
|
$2,820.00
|
|
|
Service Code
|
HCPCS 71552
|
| Hospital Charge Code |
H6100108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,397.00 |
| Max. Negotiated Rate |
$2,735.40 |
| Rate for Payer: Cash Price |
$1,833.00
|
| Rate for Payer: Health Management Network Commercial |
$2,397.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,735.40
|
|
|
HCHG CHEST PA LAT 2 VIEW
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240114
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| 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 |
$23.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$359.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$552.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG CHEST PA LAT 2 VIEW
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 71046
|
| Hospital Charge Code |
H3240114
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$484.50 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: MDX Hawaii PPO |
$552.90
|
|
|
HCHG CHEST PA & LATERAL WITH BILAT OBLIQUES 4 VIEWS
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
H3240129
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| 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 |
$29.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$318.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$86.36
|
|
|
HCHG CHEST PA & LATERAL WITH BILAT OBLIQUES 4 VIEWS
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 71048
|
| Hospital Charge Code |
H3240129
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
|
|
HCHG CHEST PA & LATERAL WITH UNILAT DUCUBITUS 3 VIEWS
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
H3240125
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$543.20 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.39
|
| 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 |
$27.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$476.00
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$285.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$543.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$80.64
|
|
|
HCHG CHEST PA & LATERAL WITH UNILAT DUCUBITUS 3 VIEWS
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 71047
|
| Hospital Charge Code |
H3240125
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$543.20 |
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Health Management Network Commercial |
$476.00
|
| Rate for Payer: MDX Hawaii PPO |
$543.20
|
|
|
HCHG CHEST PA ONLY 1 VIEW
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS 71045
|
| Hospital Charge Code |
H3240116
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$470.45 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Cash Price |
$315.25
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| 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 |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$412.25
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$305.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$247.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$470.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$40.29
|
|
