|
HCHG NASAL BONES MIN 3 VIEWS
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 70160
|
| Hospital Charge Code |
H3200580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$614.01 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$411.45
|
| Rate for Payer: Cash Price |
$411.45
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| 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 |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$538.05
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$398.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$322.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$614.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$63.38
|
|
|
HCHG NASAL HEMORR ANT(CMPLX/EXTEN)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
H4500568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| 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 |
$157.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$665.00
|
| Rate for Payer: Health Management Network Commercial |
$595.00
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$679.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$510.23
|
|
|
HCHG NASAL HEMORR ANT(CMPLX/EXTEN)
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
H4500568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$679.00 |
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Health Management Network Commercial |
$595.00
|
| Rate for Payer: MDX Hawaii PPO |
$679.00
|
|
|
HCHG NASAL HEMORR ANT SIMPLE
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
H4500570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| 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 |
$157.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
|
HCHG NASAL HEMORR ANT SIMPLE
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
H4500570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG NASAL HEMORR POST INITIAL
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
H4500572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.18 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| 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 |
$157.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$794.20
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$526.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$609.36
|
|
|
HCHG NASAL HEMORR POST INITIAL
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
H4500572
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.60 |
| Max. Negotiated Rate |
$810.92 |
| Rate for Payer: Cash Price |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$810.92
|
|
|
HCHG NASO/ORO G TUBE PLCMT MD
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
H4500574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$2,176.68 |
| Rate for Payer: AlohaCare Medicaid |
$527.74
|
| Rate for Payer: AlohaCare Medicare |
$527.74
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Devoted Health Medicare |
$580.51
|
| 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 |
$527.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,131.80
|
| Rate for Payer: Health Management Network Commercial |
$1,907.40
|
| Rate for Payer: Humana Medicare |
$527.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,413.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$527.74
|
| Rate for Payer: MDX Hawaii PPO |
$2,176.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$580.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$527.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$527.74
|
| Rate for Payer: University Health Alliance Commercial |
$1,635.65
|
|
|
HCHG NASO/ORO G TUBE PLCMT MD
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
H4500574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,907.40 |
| Max. Negotiated Rate |
$2,176.68 |
| Rate for Payer: Cash Price |
$1,458.60
|
| Rate for Payer: Health Management Network Commercial |
$1,907.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,176.68
|
|
|
HCHG NASOTRACHEAL SXN/AIRWAY MGMT
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 31720
|
| Hospital Charge Code |
H4100304
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$355.30 |
| Max. Negotiated Rate |
$405.46 |
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: MDX Hawaii PPO |
$405.46
|
|
|
HCHG NASOTRACHEAL SXN/AIRWAY MGMT
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 31720
|
| Hospital Charge Code |
H4100304
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$47.17 |
| Max. Negotiated Rate |
$2,833.00 |
| Rate for Payer: AlohaCare Medicaid |
$258.69
|
| Rate for Payer: AlohaCare Medicare |
$258.69
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Devoted Health Medicare |
$284.56
|
| 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 |
$258.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$397.10
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: Humana Medicare |
$258.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$263.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$213.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.69
|
| Rate for Payer: MDX Hawaii PPO |
$405.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$284.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$258.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$258.69
|
| Rate for Payer: University Health Alliance Commercial |
$304.68
|
|
|
HCHG NATURAL KILLER CELLS
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
H3110224
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
|
HCHG NATURAL KILLER CELLS
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
H3110224
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: AlohaCare Medicaid |
$37.73
|
| Rate for Payer: AlohaCare Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Cash Price |
$252.85
|
| Rate for Payer: Devoted Health Medicare |
$41.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.73
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.73
|
| Rate for Payer: University Health Alliance Commercial |
$97.50
|
|
|
HCHG N BLOCK LUMBAR/THORACIC
|
Facility
|
OP
|
$3,310.00
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
H3610835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,044.87
|
| Rate for Payer: AlohaCare Medicare |
$1,044.87
|
| Rate for Payer: Cash Price |
$2,151.50
|
| Rate for Payer: Cash Price |
$2,151.50
|
| Rate for Payer: Cash Price |
$2,151.50
|
| Rate for Payer: Devoted Health Medicare |
$1,149.36
|
| 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 |
$1,044.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$2,813.50
|
| Rate for Payer: Humana Medicare |
$1,044.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,085.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,044.87
|
| Rate for Payer: MDX Hawaii PPO |
$3,210.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,149.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,044.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,044.87
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG N BLOCK LUMBAR/THORACIC
|
Facility
|
IP
|
$3,310.00
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
H3610835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,813.50 |
| Max. Negotiated Rate |
$3,210.70 |
| Rate for Payer: Cash Price |
$2,151.50
|
| Rate for Payer: Health Management Network Commercial |
$2,813.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,210.70
|
|
|
HCHG NECK SOFT TISSUE
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
H3200582
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.82
|
| 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 |
$15.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG NECK SOFT TISSUE
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
H3200582
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HCHG NECK SOFT TISSUE PORT
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
H3200584
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.82
|
| 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 |
$15.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG NECK SOFT TISSUE PORT
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 70360
|
| Hospital Charge Code |
H3200584
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HCHG NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
H4501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.02 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$237.02
|
| Rate for Payer: AlohaCare Medicare |
$237.02
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| 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 |
$401.85
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
| 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 |
$308.32
|
|
|
HCHG NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
H4501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
|
|
HCHG NEPHELOMETRY EA NES SO
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
K3010041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$13.60
|
| Rate for Payer: AlohaCare Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$14.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.60
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.15
|
|
|
HCHG NEPHELOMETRY EA NES SO
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
K3010041
|
|
Hospital Revenue Code
|
301
|
| 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 NERVE BLOCK INJECTION, PLANTAR DIGIT
|
Facility
|
OP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
H4501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,669.37 |
| 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: Cash Price |
$1,118.65
|
| Rate for Payer: Devoted Health Medicare |
$398.88
|
| 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 |
$362.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,634.95
|
| 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 |
$937.50
|
| 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 Medicare |
$362.62
|
| Rate for Payer: University Health Alliance Commercial |
$1,254.44
|
|
|
HCHG NERVE BLOCK INJECTION, PLANTAR DIGIT
|
Facility
|
IP
|
$1,721.00
|
|
|
Service Code
|
HCPCS 64455
|
| Hospital Charge Code |
H4501003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,462.85 |
| Max. Negotiated Rate |
$1,669.37 |
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
| Rate for Payer: Cash Price |
$1,118.65
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
|
