|
HCHG LEGION PNEUMO DNA AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
H3060802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| 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 |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG LEPTOSPIRA AB 90
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
H3020630
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HCHG LEPTOSPIRA AB 90
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
H3020630
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$16.20
|
| Rate for Payer: AlohaCare Medicare |
$16.20
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$17.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.20
|
| Rate for Payer: University Health Alliance Commercial |
$34.10
|
|
|
HCHG LEVEL IV GROSS MICRO EXAM
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
H3120307
|
|
Hospital Revenue Code
|
312
|
| 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 LEVEL IV GROSS MICRO EXAM
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
H3120307
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$40.64 |
| 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 |
$40.64
|
| 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 |
$49.53
|
| 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 |
$40.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.56
|
| Rate for Payer: University Health Alliance Commercial |
$207.96
|
|
|
HCHG LEVETIRACETAM QUANT
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
H3011340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$13.25
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.25
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG LEVETIRACETAM QUANT
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
H3011340
|
|
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 LIGATION MAJOR ARTERY; EXTREMITY
|
Facility
|
IP
|
$1,817.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
H4501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,544.45 |
| Max. Negotiated Rate |
$1,762.49 |
| Rate for Payer: Cash Price |
$1,181.05
|
| Rate for Payer: Health Management Network Commercial |
$1,544.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,762.49
|
|
|
HCHG LIGATION MAJOR ARTERY; EXTREMITY
|
Facility
|
OP
|
$1,817.00
|
|
|
Service Code
|
HCPCS 37618
|
| Hospital Charge Code |
H4501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$848.00 |
| Max. Negotiated Rate |
$9,416.00 |
| Rate for Payer: Cash Price |
$1,181.05
|
| Rate for Payer: Cash Price |
$1,181.05
|
| 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 Non-ABD |
$849.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,726.15
|
| Rate for Payer: Health Management Network Commercial |
$1,544.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,144.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,762.49
|
| Rate for Payer: University Health Alliance Commercial |
$1,324.41
|
|
|
HCHG LIPASE
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: AlohaCare Medicaid |
$6.89
|
| Rate for Payer: AlohaCare Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Devoted Health Medicare |
$7.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Humana Medicare |
$6.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.89
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.89
|
| Rate for Payer: University Health Alliance Commercial |
$17.80
|
|
|
HCHG LIPASE
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
|
|
HCHG LIPASE BODY FLUID
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: AlohaCare Medicaid |
$6.89
|
| Rate for Payer: AlohaCare Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Devoted Health Medicare |
$7.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Humana Medicare |
$6.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.89
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.89
|
| Rate for Payer: University Health Alliance Commercial |
$17.80
|
|
|
HCHG LIPASE BODY FLUID
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
|
|
HCHG LIPOPROTEIN A
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
H3011385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HCHG LIPOPROTEIN A
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
H3011385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$14.32
|
| Rate for Payer: AlohaCare Medicare |
$14.32
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Devoted Health Medicare |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.32
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$14.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.32
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.32
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG LITHIUM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
H3010842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: AlohaCare Medicaid |
$6.61
|
| Rate for Payer: AlohaCare Medicare |
$6.61
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Devoted Health Medicare |
$7.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.61
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Humana Medicare |
$6.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.61
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.61
|
| Rate for Payer: University Health Alliance Commercial |
$17.09
|
|
|
HCHG LITHIUM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
H3010842
|
|
Hospital Revenue Code
|
301
|
| 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 LIVER ELASTOGRAPHY
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
HCPCS 91200
|
| Hospital Charge Code |
K4021000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$820.25 |
| Max. Negotiated Rate |
$936.05 |
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: MDX Hawaii PPO |
$936.05
|
|
|
HCHG LIVER ELASTOGRAPHY
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
HCPCS 91200
|
| Hospital Charge Code |
K4021000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$936.05 |
| Rate for Payer: AlohaCare Medicaid |
$152.01
|
| Rate for Payer: AlohaCare Medicare |
$152.01
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Cash Price |
$627.25
|
| Rate for Payer: Devoted Health Medicare |
$167.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$190.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$916.75
|
| Rate for Payer: Health Management Network Commercial |
$820.25
|
| Rate for Payer: Humana Medicare |
$152.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$607.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$492.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.01
|
| Rate for Payer: MDX Hawaii PPO |
$936.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.01
|
| Rate for Payer: University Health Alliance Commercial |
$703.39
|
|
|
HCHG LIVER IMAG W VASC FLOW
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 78202
|
| Hospital Charge Code |
H3410242
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$2,629.67 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,762.15
|
| Rate for Payer: Cash Price |
$1,762.15
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,304.35
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,707.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,382.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,629.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$376.40
|
|
|
HCHG LIVER IMAG W VASC FLOW
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
HCPCS 78202
|
| Hospital Charge Code |
H3410242
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,304.35 |
| Max. Negotiated Rate |
$2,629.67 |
| Rate for Payer: Cash Price |
$1,762.15
|
| Rate for Payer: Health Management Network Commercial |
$2,304.35
|
| Rate for Payer: MDX Hawaii PPO |
$2,629.67
|
|
|
HCHG LIVER-KIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$14.55
|
| Rate for Payer: AlohaCare Medicare |
$14.55
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$16.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.55
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$14.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.55
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.55
|
| Rate for Payer: University Health Alliance Commercial |
$37.61
|
|
|
HCHG LIVER-KIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020632
|
|
Hospital Revenue Code
|
302
|
| 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 LIVER/SPLEEN/FLOW
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
HCPCS 78216
|
| Hospital Charge Code |
H3410212
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$1,837.18 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,231.10
|
| Rate for Payer: Cash Price |
$1,231.10
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$124.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,609.90
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,193.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$965.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,837.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$306.67
|
|
|
HCHG LIVER/SPLEEN/FLOW
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
HCPCS 78216
|
| Hospital Charge Code |
H3410212
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,609.90 |
| Max. Negotiated Rate |
$1,837.18 |
| Rate for Payer: Cash Price |
$1,231.10
|
| Rate for Payer: Health Management Network Commercial |
$1,609.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,837.18
|
|
