|
HCHG CT UPP EXTREM W CONTR
|
Facility
|
OP
|
$2,261.00
|
|
|
Service Code
|
HCPCS 73201
|
| Hospital Charge Code |
H3520174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$194.84 |
| Max. Negotiated Rate |
$2,193.17 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$1,469.65
|
| Rate for Payer: Cash Price |
$1,469.65
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$194.84
|
| 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 |
$211.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,921.85
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,424.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,153.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$2,193.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$194.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$659.17
|
|
|
HCHG CT UPP EXTREM W/O CONTRAST
|
Facility
|
OP
|
$1,730.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
H3520170
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$1,678.10 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$1,124.50
|
| Rate for Payer: Cash Price |
$1,124.50
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$163.33
|
| 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 |
$177.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$1,470.50
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,089.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$882.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,678.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$497.32
|
|
|
HCHG CT UPP EXTREM W/O CONTRAST
|
Facility
|
IP
|
$1,730.00
|
|
|
Service Code
|
HCPCS 73200
|
| Hospital Charge Code |
H3520170
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,470.50 |
| Max. Negotiated Rate |
$1,678.10 |
| Rate for Payer: Cash Price |
$1,124.50
|
| Rate for Payer: Health Management Network Commercial |
$1,470.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,678.10
|
|
|
HCHG CT UPP EXTREM W/WO CONTR
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
H3520172
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$207.21 |
| Max. Negotiated Rate |
$1,994.32 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$1,336.40
|
| Rate for Payer: Cash Price |
$1,336.40
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$244.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$267.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$1,747.60
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,295.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,048.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$1,994.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$244.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$785.42
|
|
|
HCHG CT UPP EXTREM W/WO CONTR
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS 73202
|
| Hospital Charge Code |
H3520172
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,747.60 |
| Max. Negotiated Rate |
$1,994.32 |
| Rate for Payer: Cash Price |
$1,336.40
|
| Rate for Payer: Health Management Network Commercial |
$1,747.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,994.32
|
|
|
HCHG CULT ANAEROBIC ISOL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
H3060142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$156.17 |
| Rate for Payer: AlohaCare Medicaid |
$9.47
|
| Rate for Payer: AlohaCare Medicare |
$9.47
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Devoted Health Medicare |
$10.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.47
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Humana Medicare |
$9.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.47
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.47
|
| Rate for Payer: University Health Alliance Commercial |
$24.46
|
|
|
HCHG CULT ANAEROBIC ISOL
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
H3060142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.85 |
| Max. Negotiated Rate |
$156.17 |
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
|
|
HCHG CULT BACTERIAL MISC
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060144
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: AlohaCare Medicaid |
$8.62
|
| Rate for Payer: AlohaCare Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$9.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$8.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.62
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.62
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT BACTERIAL MISC
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060144
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
HCHG CULT BETA STREP
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
H3060146
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
|
|
HCHG CULT BETA STREP
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
H3060146
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: AlohaCare Medicaid |
$6.63
|
| Rate for Payer: AlohaCare Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Devoted Health Medicare |
$7.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.63
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.63
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.63
|
| Rate for Payer: University Health Alliance Commercial |
$17.13
|
|
|
HCHG CULT BLOOD
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
H3060148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$10.32
|
| Rate for Payer: AlohaCare Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$11.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$10.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.32
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.32
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
HCHG CULT BLOOD
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
H3060148
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG CULT BODY FLUID
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
HCHG CULT BODY FLUID
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060150
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: AlohaCare Medicaid |
$8.62
|
| Rate for Payer: AlohaCare Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$9.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$8.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.62
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.62
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT CSF
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
HCHG CULT CSF
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: AlohaCare Medicaid |
$8.62
|
| Rate for Payer: AlohaCare Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$9.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$8.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.62
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.62
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT FUNGI BLOOD
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 87103
|
| Hospital Charge Code |
H3060158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$20.46
|
| Rate for Payer: AlohaCare Medicare |
$20.46
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$22.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.46
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$20.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.46
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.46
|
| Rate for Payer: University Health Alliance Commercial |
$23.31
|
|
|
HCHG CULT FUNGI BLOOD
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 87103
|
| Hospital Charge Code |
H3060158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG CULT FUNGI ISOLATION
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
H3060160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
HCHG CULT FUNGI ISOLATION
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
H3060160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$8.41
|
| Rate for Payer: AlohaCare Medicare |
$8.41
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$9.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.41
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$8.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.41
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.41
|
| Rate for Payer: University Health Alliance Commercial |
$21.72
|
|
|
HCHG CULT GC
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
H3060162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
|
|
HCHG CULT GC
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
H3060162
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: AlohaCare Medicaid |
$6.63
|
| Rate for Payer: AlohaCare Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Devoted Health Medicare |
$7.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.63
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.63
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.63
|
| Rate for Payer: University Health Alliance Commercial |
$17.13
|
|
|
HCHG CULT MISC
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060166
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
HCHG CULT MISC
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060166
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: AlohaCare Medicaid |
$8.62
|
| Rate for Payer: AlohaCare Medicare |
$8.62
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$9.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$8.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.62
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.62
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
