|
HCHG CLTX INTERPHALAGEAL JOINT DISCLOSURE W/ ANES
|
Facility
|
OP
|
$1,487.00
|
|
|
Service Code
|
HCPCS 28665
|
| Hospital Charge Code |
H4501140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$330.41 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$330.41
|
| Rate for Payer: AlohaCare Medicare |
$330.41
|
| Rate for Payer: Cash Price |
$966.55
|
| Rate for Payer: Cash Price |
$966.55
|
| Rate for Payer: Cash Price |
$966.55
|
| Rate for Payer: Devoted Health Medicare |
$363.45
|
| 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 |
$330.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,412.65
|
| Rate for Payer: Health Management Network Commercial |
$1,263.95
|
| Rate for Payer: Humana Medicare |
$330.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$936.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.41
|
| Rate for Payer: MDX Hawaii PPO |
$1,442.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$363.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$330.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$330.41
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CLTX INTERPHALAGEAL JOINT DISCLOSURE W/ ANES
|
Facility
|
IP
|
$1,487.00
|
|
|
Service Code
|
HCPCS 28665
|
| Hospital Charge Code |
H4501140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,263.95 |
| Max. Negotiated Rate |
$1,442.39 |
| Rate for Payer: Cash Price |
$966.55
|
| Rate for Payer: Health Management Network Commercial |
$1,263.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,442.39
|
|
|
HCHG CL TX TROCH FEM FX W MANIPULATION
|
Facility
|
IP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
H4501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,264.00 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Health Management Network Commercial |
$3,264.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,724.80
|
|
|
HCHG CL TX TROCH FEM FX W MANIPULATION
|
Facility
|
OP
|
$3,840.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
H4501035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Cash Price |
$2,496.00
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| 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 |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,648.00
|
| Rate for Payer: Health Management Network Commercial |
$3,264.00
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,419.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$3,724.80
|
| 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 |
$2,798.98
|
|
|
HCHG CMV AB IGM
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
H3020416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$16.85
|
| Rate for Payer: AlohaCare Medicare |
$16.85
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$18.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$16.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.85
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.85
|
| Rate for Payer: University Health Alliance Commercial |
$43.55
|
|
|
HCHG CMV AB IGM
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
H3020416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
HCHG CMV AB SCRN 1 UNIT 90
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
H3020420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$229.89 |
| Rate for Payer: AlohaCare Medicaid |
$14.39
|
| Rate for Payer: AlohaCare Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$154.05
|
| Rate for Payer: Cash Price |
$154.05
|
| Rate for Payer: Devoted Health Medicare |
$15.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$201.45
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.39
|
| Rate for Payer: MDX Hawaii PPO |
$229.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.39
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HCHG CMV AB SCRN 1 UNIT 90
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
H3020420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$201.45 |
| Max. Negotiated Rate |
$229.89 |
| Rate for Payer: Cash Price |
$154.05
|
| Rate for Payer: Health Management Network Commercial |
$201.45
|
| Rate for Payer: MDX Hawaii PPO |
$229.89
|
|
|
HCHG CMV IGG
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
H3020432
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: AlohaCare Medicaid |
$14.39
|
| Rate for Payer: AlohaCare Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$15.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.39
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.39
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HCHG CMV IGG
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
H3020432
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
HCHG CNB LYMPH NODE WO IMG GUIDE
|
Facility
|
IP
|
$3,026.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
H3600172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,572.10 |
| Max. Negotiated Rate |
$2,935.22 |
| Rate for Payer: Cash Price |
$1,966.90
|
| Rate for Payer: Health Management Network Commercial |
$2,572.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,935.22
|
|
|
HCHG CNB LYMPH NODE WO IMG GUIDE
|
Facility
|
OP
|
$3,026.00
|
|
|
Service Code
|
HCPCS 38505
|
| Hospital Charge Code |
H3600172
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$2,935.22 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$1,966.90
|
| Rate for Payer: Cash Price |
$1,966.90
|
| Rate for Payer: Cash Price |
$1,966.90
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,438.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Health Management Network Commercial |
$2,572.10
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,906.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$2,935.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$2,205.65
|
|
|
HCHG CNS DNA AMP PROBE 12-25 - 90
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 87483
|
| Hospital Charge Code |
H3060808
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$343.03 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: AlohaCare Medicaid |
$416.78
|
| Rate for Payer: AlohaCare Medicare |
$416.78
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Devoted Health Medicare |
$458.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$463.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$520.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$416.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$741.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$416.78
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Humana Medicare |
$416.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,193.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$966.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.78
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$458.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$416.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$343.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$416.78
|
| Rate for Payer: University Health Alliance Commercial |
$1,381.27
|
|
|
HCHG CNS DNA AMP PROBE 12-25 - 90
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 87483
|
| Hospital Charge Code |
H3060808
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,610.75 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
|
|
HCHG CO2
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
H3010394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
HCHG CO2
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
H3010394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$4.88
|
| Rate for Payer: AlohaCare Medicare |
$4.88
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Devoted Health Medicare |
$5.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.88
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$4.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.88
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.88
|
| Rate for Payer: University Health Alliance Commercial |
$12.64
|
|
|
HCHG COCAINE DRUG CONFIRM 90
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
H3011578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.05
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
|
|
HCHG COCAINE DRUG CONFIRM 90
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
H3011578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HCHG COCCIDIOIDES AB 90
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
H3020434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: AlohaCare Medicaid |
$11.47
|
| Rate for Payer: AlohaCare Medicare |
$11.47
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$12.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.47
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$11.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.47
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.47
|
| Rate for Payer: University Health Alliance Commercial |
$29.66
|
|
|
HCHG COCCIDIOIDES AB 90
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 86635
|
| Hospital Charge Code |
H3020434
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HCHG COCCIDIOIDES AG QNT EIA SO
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
K3060034
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$263.84 |
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Management Network Commercial |
$231.20
|
| Rate for Payer: MDX Hawaii PPO |
$263.84
|
|
|
HCHG COCCIDIOIDES AG QNT EIA SO
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
K3060034
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$263.84 |
| Rate for Payer: AlohaCare Medicaid |
$11.98
|
| Rate for Payer: AlohaCare Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| 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 |
$231.20
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$138.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.98
|
| Rate for Payer: MDX Hawaii PPO |
$263.84
|
| 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 CODE BLUE
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
H4800112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| 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 |
$255.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,710.00
|
| Rate for Payer: Health Management Network Commercial |
$1,530.00
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,134.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$918.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$1,746.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$1,312.02
|
|
|
HCHG CODE BLUE
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
H4800112
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$1,746.00 |
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Health Management Network Commercial |
$1,530.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,746.00
|
|
|
HCHG CODE BLUE NURSERY
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 99465
|
| Hospital Charge Code |
H3600180
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,092.25 |
| Max. Negotiated Rate |
$1,246.45 |
| Rate for Payer: Cash Price |
$835.25
|
| Rate for Payer: Health Management Network Commercial |
$1,092.25
|
| Rate for Payer: MDX Hawaii PPO |
$1,246.45
|
|
