|
HCHG CRYPTOSPORIDIUM DETECTION BY IF
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
H3060624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG CRYPTOSPORIDIUM DETECTION BY IF
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
H3060624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: AlohaCare Medicaid |
$11.98
|
| Rate for Payer: AlohaCare Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| 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 |
$77.35
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.98
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| 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 CRYPTOSPORIDUM AG EIA SO
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
K3060027
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$13.82
|
| Rate for Payer: AlohaCare Medicare |
$13.82
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$15.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.82
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$13.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.82
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.82
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG CRYPTOSPORIDUM AG EIA SO
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 87328
|
| Hospital Charge Code |
K3060027
|
|
Hospital Revenue Code
|
306
|
| 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 CRYSTAL EXAM-BODY FLD
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
H3090112
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$7.33
|
| Rate for Payer: AlohaCare Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$7.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.33
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.33
|
| Rate for Payer: University Health Alliance Commercial |
$18.48
|
|
|
HCHG CRYSTAL EXAM-BODY FLD
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
H3090112
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HCHG C-SPINE 2-3 VIEWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200292
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$487.05 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
|
|
HCHG C-SPINE 2-3 VIEWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200292
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| 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 |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C-SPINE 2-3 VIEWS PORT
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
|
|
HCHG C-SPINE 2-3 VIEWS PORT
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| 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 |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C-SPINE 4 OR 5 VIEWS
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
H3200917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| 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 |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$105.14
|
|
|
HCHG C-SPINE 4 OR 5 VIEWS
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 72050
|
| Hospital Charge Code |
H3200917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG C-SPINE 6 VIEWS OR >
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
H3200296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.85 |
| Max. Negotiated Rate |
$721.68 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.85
|
| 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 |
$41.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$379.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$721.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$132.40
|
|
|
HCHG C-SPINE 6 VIEWS OR >
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 72052
|
| Hospital Charge Code |
H3200296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$721.68 |
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: MDX Hawaii PPO |
$721.68
|
|
|
HCHG C- SPINE AP & LAT ONLY
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| 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 |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C- SPINE AP & LAT ONLY
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$487.05 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
|
|
HCHG C- SPINE FLEX/EXT ONLY 2-3VIEWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$487.05 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
|
|
HCHG C- SPINE FLEX/EXT ONLY 2-3VIEWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 72040
|
| Hospital Charge Code |
H3200228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.78
|
| 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 |
$21.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$73.65
|
|
|
HCHG C- SPINE LAT ONLY/SWIM 1 VIEW
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
H3200230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$401.58 |
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: MDX Hawaii PPO |
$401.58
|
|
|
HCHG C- SPINE LAT ONLY/SWIM 1 VIEW
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 72020
|
| Hospital Charge Code |
H3200230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$401.58 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.98
|
| 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 |
$15.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$401.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$48.36
|
|
|
HCHG C- SPINE MRI WO CONTR
|
Facility
|
IP
|
$2,180.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
H6120102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,853.00 |
| Max. Negotiated Rate |
$2,114.60 |
| Rate for Payer: Cash Price |
$1,417.00
|
| Rate for Payer: Health Management Network Commercial |
$1,853.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,114.60
|
|
|
HCHG C- SPINE MRI WO CONTR
|
Facility
|
OP
|
$2,180.00
|
|
|
Service Code
|
HCPCS 72141
|
| Hospital Charge Code |
H6120102
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$2,114.60 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$1,417.00
|
| Rate for Payer: Cash Price |
$1,417.00
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$396.10
|
| 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 |
$415.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$1,853.00
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,373.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,111.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$2,114.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$396.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$856.18
|
|
|
HCHG C-SPINE MRI W/WO CONTR
|
Facility
|
OP
|
$3,381.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
H6120104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$3,279.57 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$2,197.65
|
| Rate for Payer: Cash Price |
$2,197.65
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$819.67
|
| 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 |
$883.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$2,873.85
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,130.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,724.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$3,279.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$819.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,316.03
|
|
|
HCHG C-SPINE MRI W/WO CONTR
|
Facility
|
IP
|
$3,381.00
|
|
|
Service Code
|
HCPCS 72156
|
| Hospital Charge Code |
H6120104
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,873.85 |
| Max. Negotiated Rate |
$3,279.57 |
| Rate for Payer: Cash Price |
$2,197.65
|
| Rate for Payer: Health Management Network Commercial |
$2,873.85
|
| Rate for Payer: MDX Hawaii PPO |
$3,279.57
|
|
|
HCHG CTA ABD&PELVIS, W/CONT, INCL NON CONTR IMG IF PERF IMG PROCESS
|
Facility
|
IP
|
$3,826.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
H3520196
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,252.10 |
| Max. Negotiated Rate |
$3,711.22 |
| Rate for Payer: Cash Price |
$2,486.90
|
| Rate for Payer: Health Management Network Commercial |
$3,252.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,711.22
|
|
