|
HCHG FILM OF BREAST BX TISSUE
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200372
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: AlohaCare Medicaid |
$645.50
|
| Rate for Payer: AlohaCare Medicare |
$645.50
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Devoted Health Medicare |
$710.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$806.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$645.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.50
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Humana Medicare |
$645.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,830.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,481.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$645.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$645.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$645.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.66
|
|
|
HCHG FINE NDL ASP SM-BX EX
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
H3110180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: AlohaCare Medicaid |
$61.56
|
| Rate for Payer: AlohaCare Medicare |
$61.56
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Devoted Health Medicare |
$67.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$76.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.56
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.56
|
| Rate for Payer: University Health Alliance Commercial |
$262.68
|
|
|
HCHG FINE NDL ASP SM-BX EX
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
H3110180
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
|
|
HCHG FINGERS MIN 2 VWS
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
H3200374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$495.67 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$332.15
|
| Rate for Payer: Cash Price |
$332.15
|
| 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 |
$434.35
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$495.67
|
| 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 |
$54.96
|
|
|
HCHG FINGERS MIN 2 VWS
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 73140
|
| Hospital Charge Code |
H3200374
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$434.35 |
| Max. Negotiated Rate |
$495.67 |
| Rate for Payer: Cash Price |
$332.15
|
| Rate for Payer: Health Management Network Commercial |
$434.35
|
| Rate for Payer: MDX Hawaii PPO |
$495.67
|
|
|
HCHG FLECAINIDE - 90
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 80181
|
| Hospital Charge Code |
H3011765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: AlohaCare Medicaid |
$18.64
|
| Rate for Payer: AlohaCare Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.64
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.64
|
| Rate for Payer: University Health Alliance Commercial |
$100.59
|
|
|
HCHG FLECAINIDE - 90
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 80181
|
| Hospital Charge Code |
H3011765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
HCHG FLECAINIDE 90
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
H3010608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
|
|
HCHG FLECAINIDE 90
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
H3010608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: AlohaCare Medicaid |
$18.64
|
| Rate for Payer: AlohaCare Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Devoted Health Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Humana Medicare |
$18.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.64
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.64
|
| Rate for Payer: University Health Alliance Commercial |
$35.39
|
|
|
HCHG FLOW CYTOMETRY TC 1ST MARKER
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
H3110272
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$763.30 |
| Max. Negotiated Rate |
$871.06 |
| Rate for Payer: Cash Price |
$583.70
|
| Rate for Payer: Health Management Network Commercial |
$763.30
|
| Rate for Payer: MDX Hawaii PPO |
$871.06
|
|
|
HCHG FLOW CYTOMETRY TC 1ST MARKER
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
HCPCS 88184
|
| Hospital Charge Code |
H3110272
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$871.06 |
| Rate for Payer: AlohaCare Medicaid |
$423.45
|
| Rate for Payer: AlohaCare Medicare |
$423.45
|
| Rate for Payer: Cash Price |
$583.70
|
| Rate for Payer: Cash Price |
$583.70
|
| Rate for Payer: Devoted Health Medicare |
$465.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$529.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.45
|
| Rate for Payer: Health Management Network Commercial |
$763.30
|
| Rate for Payer: Humana Medicare |
$423.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$457.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.45
|
| Rate for Payer: MDX Hawaii PPO |
$871.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.45
|
| Rate for Payer: University Health Alliance Commercial |
$152.44
|
|
|
HCHG FLOW CYTOMETRY TC ADD MRKS
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 88185
|
| Hospital Charge Code |
H3110274
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.35
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.23
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.96
|
| Rate for Payer: University Health Alliance Commercial |
$86.75
|
|
|
HCHG FLOW CYTOMETRY TC ADD MRKS
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 88185
|
| Hospital Charge Code |
H3110274
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
HCHG FLT3 (ITD) MUTATION ANALYSIS - 90
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
H3100188
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$875.91 |
| Rate for Payer: AlohaCare Medicaid |
$165.51
|
| Rate for Payer: AlohaCare Medicare |
$165.51
|
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Devoted Health Medicare |
$182.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.51
|
| Rate for Payer: Health Management Network Commercial |
$767.55
|
| Rate for Payer: Humana Medicare |
$165.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$568.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$460.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.51
|
| Rate for Payer: MDX Hawaii PPO |
$875.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.51
|
| Rate for Payer: University Health Alliance Commercial |
$207.20
|
|
|
HCHG FLT3 (ITD) MUTATION ANALYSIS - 90
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
H3100188
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$767.55 |
| Max. Negotiated Rate |
$875.91 |
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Health Management Network Commercial |
$767.55
|
| Rate for Payer: MDX Hawaii PPO |
$875.91
|
|
|
HCHG FLT3 (TKD) MUTATION ANALYSIS - 90
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 81246
|
| Hospital Charge Code |
H3100189
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$429.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
|
|
HCHG FLT3 (TKD) MUTATION ANALYSIS - 90
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 81246
|
| Hospital Charge Code |
H3100189
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$489.85 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$83.00
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Cash Price |
$328.25
|
| Rate for Payer: Devoted Health Medicare |
$91.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$83.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$103.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.00
|
| Rate for Payer: Health Management Network Commercial |
$429.25
|
| Rate for Payer: Humana Medicare |
$83.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$318.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.00
|
| Rate for Payer: MDX Hawaii PPO |
$489.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.00
|
| Rate for Payer: University Health Alliance Commercial |
$368.09
|
|
|
HCHG FLUORESCENT ANTIBODY SCREEN - 90
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3021062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
|
|
HCHG FLUORESCENT ANTIBODY SCREEN - 90
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3021062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG FLUORO ARTHROCENTESIS LARGE JOINT
|
Facility
|
OP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
H3200949
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$362.62
|
| Rate for Payer: AlohaCare Medicare |
$362.62
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Devoted Health Medicare |
$398.88
|
| 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 |
$362.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Humana Medicare |
$362.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,084.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$362.62
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$362.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$362.62
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG FLUORO ARTHROCENTESIS LARGE JOINT
|
Facility
|
IP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
H3200949
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,462.85 |
| Max. Negotiated Rate |
$1,669.37 |
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
|
|
HCHG FLUORO ARTHROCENTESIS SMALL JOINT
|
Facility
|
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
H3200947
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$362.62
|
| Rate for Payer: AlohaCare Medicare |
$362.62
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Devoted Health Medicare |
$398.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$453.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$362.62
|
| Rate for Payer: Health Management Network Commercial |
$1,575.90
|
| Rate for Payer: Humana Medicare |
$362.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,168.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$362.62
|
| Rate for Payer: MDX Hawaii PPO |
$1,798.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$362.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$362.62
|
| Rate for Payer: University Health Alliance Commercial |
$1,351.38
|
|
|
HCHG FLUORO ARTHROCENTESIS SMALL JOINT
|
Facility
|
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
H3200947
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,575.90 |
| Max. Negotiated Rate |
$1,798.38 |
| Rate for Payer: Cash Price |
$1,205.10
|
| Rate for Payer: Health Management Network Commercial |
$1,575.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,798.38
|
|
|
HCHG FLUORO GUIDANCE SPINE
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
H3200398
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$453.96 |
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Health Management Network Commercial |
$397.80
|
| Rate for Payer: MDX Hawaii PPO |
$453.96
|
|
|
HCHG FLUORO GUIDANCE SPINE
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
H3200398
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$453.96 |
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Cash Price |
$304.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$444.60
|
| Rate for Payer: Health Management Network Commercial |
$397.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$238.68
|
| Rate for Payer: MDX Hawaii PPO |
$453.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.83
|
| Rate for Payer: University Health Alliance Commercial |
$131.42
|
|
