|
HCHG CHROMOSOME ANALYS BLD X 90
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
H3110138
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$124.02 |
| Max. Negotiated Rate |
$966.12 |
| Rate for Payer: AlohaCare Medicaid |
$125.49
|
| Rate for Payer: AlohaCare Medicare |
$125.49
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Devoted Health Medicare |
$138.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$156.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.49
|
| Rate for Payer: Health Management Network Commercial |
$846.60
|
| Rate for Payer: Humana Medicare |
$125.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$627.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$507.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.49
|
| Rate for Payer: MDX Hawaii PPO |
$966.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.49
|
| Rate for Payer: University Health Alliance Commercial |
$322.16
|
|
|
HCHG CHROMOSOME ANALYS BLD X 90
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
H3110138
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$846.60 |
| Max. Negotiated Rate |
$966.12 |
| Rate for Payer: Cash Price |
$647.40
|
| Rate for Payer: Health Management Network Commercial |
$846.60
|
| Rate for Payer: MDX Hawaii PPO |
$966.12
|
|
|
HCHG CHYLMD PNEUM DNA AMP PROBE - 90
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
H3060801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$316.20 |
| Max. Negotiated Rate |
$360.84 |
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Health Management Network Commercial |
$316.20
|
| Rate for Payer: MDX Hawaii PPO |
$360.84
|
|
|
HCHG CHYLMD PNEUM DNA AMP PROBE - 90
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
H3060801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$360.84 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$316.20
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$189.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$360.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG CIRCUMCISION (NURSERY)
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
H7230102
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$2,550.00 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Health Management Network Commercial |
$2,550.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,910.00
|
|
|
HCHG CIRCUMCISION (NURSERY)
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
H7230102
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$2,469.46
|
| Rate for Payer: AlohaCare Medicare |
$2,469.46
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Devoted Health Medicare |
$2,716.41
|
| 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 |
$2,469.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,850.00
|
| Rate for Payer: Health Management Network Commercial |
$2,550.00
|
| Rate for Payer: Humana Medicare |
$2,469.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,890.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,530.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,469.46
|
| Rate for Payer: MDX Hawaii PPO |
$2,910.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,716.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,469.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,469.46
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
H7610178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,550.00 |
| Max. Negotiated Rate |
$2,910.00 |
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Health Management Network Commercial |
$2,550.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,910.00
|
|
|
HCHG CIRCUMCISION W/REGIONL BLOCK
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
H7610178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$2,469.46
|
| Rate for Payer: AlohaCare Medicare |
$2,469.46
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Devoted Health Medicare |
$2,716.41
|
| 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 |
$2,469.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,850.00
|
| Rate for Payer: Health Management Network Commercial |
$2,550.00
|
| Rate for Payer: Humana Medicare |
$2,469.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,890.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,530.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,469.46
|
| Rate for Payer: MDX Hawaii PPO |
$2,910.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,716.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,469.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,469.46
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CK MB 90
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
H3010382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: AlohaCare Medicaid |
$11.55
|
| Rate for Payer: AlohaCare Medicare |
$11.55
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$12.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.55
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$11.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.55
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.55
|
| Rate for Payer: University Health Alliance Commercial |
$29.84
|
|
|
HCHG CK MB 90
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
H3010382
|
|
Hospital Revenue Code
|
301
|
| 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 CLAMYDIA P AMPLIF DNA PROBE - 90
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
H3060744
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$360.84 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$316.20
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$189.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$360.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG CLAMYDIA P AMPLIF DNA PROBE - 90
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
H3060744
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$316.20 |
| Max. Negotiated Rate |
$360.84 |
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Health Management Network Commercial |
$316.20
|
| Rate for Payer: MDX Hawaii PPO |
$360.84
|
|
|
HCHG CLAVICLE COMPLETE
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
H3200282
|
|
Hospital Revenue Code
|
320
|
| 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 CLAVICLE COMPLETE
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
H3200282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| 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 |
$17.04
|
| 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 |
$18.60
|
| 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 |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.28
|
|
|
HCHG CLAVICLE PORT COMPLETE
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
H3200284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| 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 |
$17.04
|
| 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 |
$18.60
|
| 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 |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.28
|
|
|
HCHG CLAVICLE PORT COMPLETE
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
H3200284
|
|
Hospital Revenue Code
|
320
|
| 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 CLOSED TREATMENT OF ACETABULUM FRACTURE WITH MANIPULATION, WITH OR WITHOUT TRACTION
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
H4501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,570.00 |
| Max. Negotiated Rate |
$4,074.00 |
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Health Management Network Commercial |
$3,570.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,074.00
|
|
|
HCHG CLOSED TREATMENT OF ACETABULUM FRACTURE WITH MANIPULATION, WITH OR WITHOUT TRACTION
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27222
|
| Hospital Charge Code |
H4501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$4,074.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| 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 |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,990.00
|
| Rate for Payer: Health Management Network Commercial |
$3,570.00
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,646.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$4,074.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$3,061.38
|
|
|
HCHG CLOSED TREATMENT PATELLAR DISLOCATION W ANES
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
H4501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| 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 |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CLOSED TREATMENT PATELLAR DISLOCATION W ANES
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
H4501115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG CLOSED TX - POST HIP ARTHROPLASTY DISLOCATION, REQ ANESTHESIA
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
H4501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG CLOSED TX - POST HIP ARTHROPLASTY DISLOCATION, REQ ANESTHESIA
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
H4501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| 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 |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,964.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG CLOSTRIDIUM DIFFICILE TOXIN EIA
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
H3060659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
|
|
HCHG CLOSTRIDIUM DIFFICILE TOXIN EIA
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
H3060659
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: AlohaCare Medicaid |
$11.98
|
| Rate for Payer: AlohaCare Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Devoted Health Medicare |
$13.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.98
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.98
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG CLOS TX TARSOMT JNT DISLOC WO
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
H4500172
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| 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 |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,292.00
|
| Rate for Payer: Health Management Network Commercial |
$1,156.00
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$856.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,319.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$991.30
|
|
