|
HCHG DEBRIDE SKIN/SQ/MUSC/BONE
|
Facility
|
IP
|
$7,149.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
H4500382
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,076.65 |
| Max. Negotiated Rate |
$6,934.53 |
| Rate for Payer: Cash Price |
$4,646.85
|
| Rate for Payer: Health Management Network Commercial |
$6,076.65
|
| Rate for Payer: MDX Hawaii PPO |
$6,934.53
|
|
|
HCHG DEBRIDE SKIN & SUBQ TISS
|
Facility
|
IP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
H4500374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,909.10 |
| Max. Negotiated Rate |
$2,178.62 |
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
|
|
HCHG DEBRIDE SKIN & SUBQ TISS
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
H4500374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.23 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Cash Price |
$1,459.90
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| 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 |
$480.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,133.70
|
| Rate for Payer: Health Management Network Commercial |
$1,909.10
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,414.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: MDX Hawaii PPO |
$2,178.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG DECALCIFICATION PROCED
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
H3120130
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HCHG DECALCIFICATION PROCED
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
H3120130
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.65
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.61
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
HCHG DELIVERY OF PLACENTA ONLY
|
Facility
|
OP
|
$6,303.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
H7200190
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,113.91 |
| Rate for Payer: AlohaCare Medicaid |
$3,824.16
|
| Rate for Payer: AlohaCare Medicare |
$3,824.16
|
| Rate for Payer: Cash Price |
$4,096.95
|
| Rate for Payer: Cash Price |
$4,096.95
|
| Rate for Payer: Cash Price |
$4,096.95
|
| Rate for Payer: Devoted Health Medicare |
$4,206.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,780.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,824.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,987.85
|
| Rate for Payer: Health Management Network Commercial |
$5,357.55
|
| Rate for Payer: Humana Medicare |
$3,824.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,970.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,214.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,824.16
|
| Rate for Payer: MDX Hawaii PPO |
$6,113.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,206.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,824.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,824.16
|
| Rate for Payer: University Health Alliance Commercial |
$4,594.26
|
|
|
HCHG DELIVERY OF PLACENTA ONLY
|
Facility
|
IP
|
$6,303.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
H7200190
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$5,357.55 |
| Max. Negotiated Rate |
$6,113.91 |
| Rate for Payer: Cash Price |
$4,096.95
|
| Rate for Payer: Health Management Network Commercial |
$5,357.55
|
| Rate for Payer: MDX Hawaii PPO |
$6,113.91
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$428.74 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| 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 |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$428.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$375.70 |
| Max. Negotiated Rate |
$428.74 |
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
| Rate for Payer: MDX Hawaii PPO |
$428.74
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$428.74 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| 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 |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$428.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$375.70 |
| Max. Negotiated Rate |
$428.74 |
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
| Rate for Payer: MDX Hawaii PPO |
$428.74
|
|
|
HCHG DETECTION INFECTIOUS AGENT AMP PROBE
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060714
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$428.74 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| 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 |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$225.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$428.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG DETECTION INFECTIOUS AGENT AMP PROBE
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060714
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$375.70 |
| Max. Negotiated Rate |
$428.74 |
| Rate for Payer: Cash Price |
$287.30
|
| Rate for Payer: Health Management Network Commercial |
$375.70
|
| Rate for Payer: MDX Hawaii PPO |
$428.74
|
|
|
HCHG DHEA-SULFATE SERUM
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
H3010472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
|
|
HCHG DHEA-SULFATE SERUM
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
H3010472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: AlohaCare Medicaid |
$22.23
|
| Rate for Payer: AlohaCare Medicare |
$22.23
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Devoted Health Medicare |
$24.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.23
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Humana Medicare |
$22.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.23
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.23
|
| Rate for Payer: University Health Alliance Commercial |
$57.48
|
|
|
HCHG DIAGNOSTIC BONE MARROW BIOPSIES WITH ASPIRATIONS
|
Facility
|
OP
|
$13,396.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
H3610674
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$12,994.12 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Cash Price |
$8,707.40
|
| Rate for Payer: Cash Price |
$8,707.40
|
| Rate for Payer: Cash Price |
$8,707.40
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| 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 |
$3,431.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$11,386.60
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,439.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: MDX Hawaii PPO |
$12,994.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,774.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,431.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,431.47
|
| Rate for Payer: University Health Alliance Commercial |
$9,764.34
|
|
|
HCHG DIAGNOSTIC BONE MARROW BIOPSIES WITH ASPIRATIONS
|
Facility
|
IP
|
$13,396.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
H3610674
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,386.60 |
| Max. Negotiated Rate |
$12,994.12 |
| Rate for Payer: Cash Price |
$8,707.40
|
| Rate for Payer: Health Management Network Commercial |
$11,386.60
|
| Rate for Payer: MDX Hawaii PPO |
$12,994.12
|
|
|
HCHG DIAGNOSTIC IMMUNO TESTING EXTRACTABLE NUCLEAR AB
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG DIAGNOSTIC IMMUNO TESTING EXTRACTABLE NUCLEAR AB
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: AlohaCare Medicaid |
$17.27
|
| Rate for Payer: AlohaCare Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$19.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.27
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.27
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG DIAZEPAM/VALIUM SO
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
K3010053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$279.65 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: MDX Hawaii PPO |
$319.13
|
|
|
HCHG DIAZEPAM/VALIUM SO
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
K3010053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: AlohaCare Medicaid |
$114.43
|
| Rate for Payer: AlohaCare Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Cash Price |
$213.85
|
| Rate for Payer: Devoted Health Medicare |
$125.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$143.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$312.55
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Humana Medicare |
$114.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.43
|
| Rate for Payer: MDX Hawaii PPO |
$319.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.43
|
| Rate for Payer: University Health Alliance Commercial |
$239.81
|
|
|
HCHG DIGOXIN
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
H3010476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: AlohaCare Medicaid |
$13.28
|
| Rate for Payer: AlohaCare Medicare |
$13.28
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Devoted Health Medicare |
$14.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.28
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Humana Medicare |
$13.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.28
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.28
|
| Rate for Payer: University Health Alliance Commercial |
$34.32
|
|
|
HCHG DIGOXIN
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
H3010476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
HCHG DILANTIN FREE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
H3010480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
HCHG DILANTIN FREE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
H3010480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: AlohaCare Medicaid |
$13.76
|
| Rate for Payer: AlohaCare Medicare |
$13.76
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Devoted Health Medicare |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.76
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$13.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.76
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.76
|
| Rate for Payer: University Health Alliance Commercial |
$35.58
|
|
