|
HCHG I&R FB SIMP
|
Facility
|
OP
|
$2,246.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
H4500490
|
|
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 IRON BINDING
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
H3010794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: AlohaCare Medicaid |
$8.74
|
| Rate for Payer: AlohaCare Medicare |
$8.74
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Devoted Health Medicare |
$9.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.74
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Humana Medicare |
$8.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.74
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.74
|
| Rate for Payer: University Health Alliance Commercial |
$22.59
|
|
|
HCHG IRON BINDING
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
H3010794
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
|
|
HCHG IRON LIVER TISSUE SO
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 82190
|
| Hospital Charge Code |
K3010023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$237.65 |
| Rate for Payer: AlohaCare Medicaid |
$15.90
|
| Rate for Payer: AlohaCare Medicare |
$15.90
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Devoted Health Medicare |
$17.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.90
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Humana Medicare |
$15.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.90
|
| Rate for Payer: MDX Hawaii PPO |
$237.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.90
|
| Rate for Payer: University Health Alliance Commercial |
$38.54
|
|
|
HCHG IRON LIVER TISSUE SO
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 82190
|
| Hospital Charge Code |
K3010023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$237.65 |
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: MDX Hawaii PPO |
$237.65
|
|
|
HCHG IRON TOT
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
H3010800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: AlohaCare Medicaid |
$6.47
|
| Rate for Payer: AlohaCare Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$7.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.47
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.47
|
| Rate for Payer: University Health Alliance Commercial |
$16.74
|
|
|
HCHG IRON TOT
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
H3010800
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
H9400138
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
HCHG IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
H9400138
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$69.69
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.25
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$69.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.69
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
| Rate for Payer: University Health Alliance Commercial |
$127.56
|
|
|
HCHG IRRIG CORPORA CAVERNOSA PRIAP
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
H4500544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,198.50 |
| Max. Negotiated Rate |
$1,367.70 |
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
|
|
HCHG IRRIG CORPORA CAVERNOSA PRIAP
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
H4500544
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.16 |
| Max. Negotiated Rate |
$9,416.00 |
| Rate for Payer: AlohaCare Medicaid |
$295.16
|
| Rate for Payer: AlohaCare Medicare |
$295.16
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$324.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,416.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,339.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Humana Medicare |
$295.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$888.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.16
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.16
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HCHG ISITU MORPH MANUAL
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS 88368
|
| Hospital Charge Code |
H3120316
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,621.80 |
| Max. Negotiated Rate |
$1,850.76 |
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Health Management Network Commercial |
$1,621.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,850.76
|
|
|
HCHG ISITU MORPH MANUAL
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS 88368
|
| Hospital Charge Code |
H3120316
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$1,850.76 |
| Rate for Payer: AlohaCare Medicaid |
$423.45
|
| Rate for Payer: AlohaCare Medicare |
$423.45
|
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Cash Price |
$1,240.20
|
| Rate for Payer: Devoted Health Medicare |
$465.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.78
|
| 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 |
$92.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.45
|
| Rate for Payer: Health Management Network Commercial |
$1,621.80
|
| Rate for Payer: Humana Medicare |
$423.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,202.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$973.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,850.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.45
|
| Rate for Payer: University Health Alliance Commercial |
$388.52
|
|
|
HCHG ISLET CELL AB SCRN RFX TO TITER
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
H3020624
|
|
Hospital Revenue Code
|
302
|
| 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 ISLET CELL AB SCRN RFX TO TITER
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
H3020624
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: AlohaCare Medicaid |
$23.57
|
| Rate for Payer: AlohaCare Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Cash Price |
$109.85
|
| Rate for Payer: Devoted Health Medicare |
$25.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Humana Medicare |
$23.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.57
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.57
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
|
|
HCHG ISLET CELL AB SO
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
K3020007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
HCHG ISLET CELL AB SO
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
K3020007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: AlohaCare Medicaid |
$23.57
|
| Rate for Payer: AlohaCare Medicare |
$23.57
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$25.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$23.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.57
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.57
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
|
|
HCHG ISOLATION ACID FAST
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
H3060300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HCHG ISOLATION ACID FAST
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
H3060300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$10.80
|
| Rate for Payer: AlohaCare Medicare |
$10.80
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$11.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$10.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.80
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.80
|
| Rate for Payer: University Health Alliance Commercial |
$25.49
|
|
|
HCHG ISOPROPANOL SO
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
K3010047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
|
|
HCHG ISOPROPANOL SO
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
K3010047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: AlohaCare Medicaid |
$17.11
|
| Rate for Payer: AlohaCare Medicare |
$17.11
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Devoted Health Medicare |
$18.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.11
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Humana Medicare |
$17.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.11
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.11
|
| Rate for Payer: University Health Alliance Commercial |
$41.53
|
|
|
HCHG ISTAT ABG
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3010804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HCHG ISTAT ABG
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3010804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$26.07
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.07
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HCHG ISTAT- LACTATE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
H3011312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.25 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
|
|
HCHG ISTAT- LACTATE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
H3011312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$11.57
|
| Rate for Payer: AlohaCare Medicare |
$11.57
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$12.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$11.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.57
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.57
|
| Rate for Payer: University Health Alliance Commercial |
$27.60
|
|
