|
HCHG I&D ABSC PERITONSILLAR
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 42700
|
| Hospital Charge Code |
H4500466
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,191.70 |
| Max. Negotiated Rate |
$1,359.94 |
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
|
|
HCHG I&D ABSC RETROPHARYNG INTRA
|
Facility
|
IP
|
$13,282.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
H4500470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11,289.70 |
| Max. Negotiated Rate |
$12,883.54 |
| Rate for Payer: Cash Price |
$8,633.30
|
| Rate for Payer: Health Management Network Commercial |
$11,289.70
|
| Rate for Payer: MDX Hawaii PPO |
$12,883.54
|
|
|
HCHG I&D ABSC RETROPHARYNG INTRA
|
Facility
|
OP
|
$13,282.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
H4500470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$12,883.54 |
| Rate for Payer: AlohaCare Medicaid |
$3,916.70
|
| Rate for Payer: AlohaCare Medicare |
$3,916.70
|
| Rate for Payer: Cash Price |
$8,633.30
|
| Rate for Payer: Cash Price |
$8,633.30
|
| Rate for Payer: Cash Price |
$8,633.30
|
| Rate for Payer: Devoted Health Medicare |
$4,308.37
|
| 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 |
$3,916.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,617.90
|
| Rate for Payer: Health Management Network Commercial |
$11,289.70
|
| Rate for Payer: Humana Medicare |
$3,916.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,367.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,916.70
|
| Rate for Payer: MDX Hawaii PPO |
$12,883.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,308.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,916.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,916.70
|
| Rate for Payer: University Health Alliance Commercial |
$9,681.25
|
|
|
HCHG I&D ABSC SIMP/SNGL
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
H4500468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$237.02
|
| Rate for Payer: AlohaCare Medicare |
$237.02
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Devoted Health Medicare |
$260.72
|
| 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 |
$237.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,171.35
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$776.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$260.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.02
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG I&D ABSC SIMP/SNGL
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
H4500468
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,048.05 |
| Max. Negotiated Rate |
$1,196.01 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: Health Management Network Commercial |
$1,048.05
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.01
|
|
|
HCHG I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
H4500472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.83 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$238.83
|
| Rate for Payer: AlohaCare Medicare |
$238.83
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Devoted Health Medicare |
$262.71
|
| 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 |
$238.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,182.75
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: Humana Medicare |
$238.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$784.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.83
|
| Rate for Payer: MDX Hawaii PPO |
$1,207.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$238.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$238.83
|
| Rate for Payer: University Health Alliance Commercial |
$907.48
|
|
|
HCHG I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 56420
|
| Hospital Charge Code |
H4500472
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,058.25 |
| Max. Negotiated Rate |
$1,207.65 |
| Rate for Payer: Cash Price |
$809.25
|
| Rate for Payer: Health Management Network Commercial |
$1,058.25
|
| Rate for Payer: MDX Hawaii PPO |
$1,207.65
|
|
|
HCHG I&D DP ABSC BURSA/HEMAT THIGH/
|
Facility
|
OP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
H4500474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,045.11 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| 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 |
$3,431.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,899.85
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,575.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
| 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 |
$6,743.44
|
|
|
HCHG I&D DP ABSC BURSA/HEMAT THIGH/
|
Facility
|
IP
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
H4500474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,173.55 |
| Max. Negotiated Rate |
$7,045.11 |
| Rate for Payer: Cash Price |
$4,720.95
|
| Rate for Payer: Health Management Network Commercial |
$6,173.55
|
| Rate for Payer: MDX Hawaii PPO |
$7,045.11
|
|
|
HCHG IDENT AEROBIC ISOL 1
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
H3060250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT AEROBIC ISOL 1
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
H3060250
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060266
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060270
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060264
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060266
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060270
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$8.08
|
| Rate for Payer: AlohaCare Medicare |
$8.08
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.08
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HCHG IDENT ANAEROBIC ISOL 1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
H3060268
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG IDENT FUNGUS ISOLATES 1
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
H3060278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$10.32
|
| Rate for Payer: AlohaCare Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$11.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.42
|
| 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 |
$15.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$10.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.32
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.32
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
HCHG IDENT FUNGUS ISOLATES 1
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
H3060278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
