|
HCHG PARATHYRD PLANAR W/WO SUBTRJ
|
Facility
|
OP
|
$2,156.00
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
H3410383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$217.03 |
| Max. Negotiated Rate |
$2,091.32 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$217.03
|
| 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 |
$281.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,832.60
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,358.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,099.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,091.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$425.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$757.91
|
|
|
HCHG PARATHYRD PLANAR W/WO SUBTRJ
|
Facility
|
IP
|
$2,156.00
|
|
|
Service Code
|
HCPCS 78071
|
| Hospital Charge Code |
H3410383
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,832.60 |
| Max. Negotiated Rate |
$2,091.32 |
| Rate for Payer: Cash Price |
$1,401.40
|
| Rate for Payer: Health Management Network Commercial |
$1,832.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,091.32
|
|
|
HCHG PARATHYROID IMAGE
|
Facility
|
IP
|
$1,323.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
H3410234
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,124.55 |
| Max. Negotiated Rate |
$1,283.31 |
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Health Management Network Commercial |
$1,124.55
|
| Rate for Payer: MDX Hawaii PPO |
$1,283.31
|
|
|
HCHG PARATHYROID IMAGE
|
Facility
|
OP
|
$1,323.00
|
|
|
Service Code
|
HCPCS 78070
|
| Hospital Charge Code |
H3410234
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$1,283.31 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Cash Price |
$859.95
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$110.12
|
| 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 |
$131.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,124.55
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$833.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$674.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,283.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$380.51
|
|
|
HCHG PARE/CUT BENIGN SKIN LESIONS
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
H4500580
|
|
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 |
$755.30
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Cash Price |
$755.30
|
| 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 |
$1,103.90
|
| Rate for Payer: Health Management Network Commercial |
$987.70
|
| Rate for Payer: Humana Medicare |
$237.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$732.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.02
|
| Rate for Payer: MDX Hawaii PPO |
$1,127.14
|
| 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 |
$846.98
|
|
|
HCHG PARE/CUT BENIGN SKIN LESIONS
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 11055
|
| Hospital Charge Code |
H4500580
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$987.70 |
| Max. Negotiated Rate |
$1,127.14 |
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Health Management Network Commercial |
$987.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,127.14
|
|
|
HCHG PARTICLE AGGLUTINATION, TITER, EA AB
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 86406
|
| Hospital Charge Code |
H3021027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: AlohaCare Medicaid |
$10.64
|
| Rate for Payer: AlohaCare Medicare |
$10.64
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Devoted Health Medicare |
$11.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.64
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Humana Medicare |
$10.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.64
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.64
|
| Rate for Payer: University Health Alliance Commercial |
$27.51
|
|
|
HCHG PARTICLE AGGLUTINATION, TITER, EA AB
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 86406
|
| Hospital Charge Code |
H3021027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
|
|
HCHG PART THRMPLSTN PTT
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
H3050196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: AlohaCare Medicaid |
$6.01
|
| Rate for Payer: AlohaCare Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$53.30
|
| Rate for Payer: Cash Price |
$53.30
|
| Rate for Payer: Devoted Health Medicare |
$6.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Humana Medicare |
$6.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.01
|
| Rate for Payer: MDX Hawaii PPO |
$79.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.01
|
| Rate for Payer: University Health Alliance Commercial |
$15.50
|
|
|
HCHG PART THRMPLSTN PTT
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
H3050196
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: Cash Price |
$53.30
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: MDX Hawaii PPO |
$79.54
|
|
|
HCHG PARVOVIRUS B-19 IGG AB
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
H3020664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HCHG PARVOVIRUS B-19 IGG AB
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
H3020664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$15.03
|
| Rate for Payer: AlohaCare Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$16.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.03
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$15.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.03
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.03
|
| Rate for Payer: University Health Alliance Commercial |
$38.85
|
|
|
HCHG PARVOVIRUS B-19 IGM AB
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
H3020666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HCHG PARVOVIRUS B-19 IGM AB
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
H3020666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$15.03
|
| Rate for Payer: AlohaCare Medicare |
$15.03
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$16.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.03
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$15.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.03
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.03
|
| Rate for Payer: University Health Alliance Commercial |
$38.85
|
|
|
HCHG PATELLA KNEE 1-2 VIEWS
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200614
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$590.73 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Cash Price |
$395.85
|
| 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 |
$517.65
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$383.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$310.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
| 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 |
$58.59
|
|
|
HCHG PATELLA KNEE 1-2 VIEWS
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200614
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$517.65 |
| Max. Negotiated Rate |
$590.73 |
| Rate for Payer: Cash Price |
$395.85
|
| Rate for Payer: Health Management Network Commercial |
$517.65
|
| Rate for Payer: MDX Hawaii PPO |
$590.73
|
|
|
HCHG PELVIS INLET OUTLET, MIN 3 VIEWS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
H3200622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$419.90 |
| Max. Negotiated Rate |
$479.18 |
| Rate for Payer: Cash Price |
$321.10
|
| Rate for Payer: Health Management Network Commercial |
$419.90
|
| Rate for Payer: MDX Hawaii PPO |
$479.18
|
|
|
HCHG PELVIS INLET OUTLET, MIN 3 VIEWS
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
H3200622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$479.18 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$321.10
|
| Rate for Payer: Cash Price |
$321.10
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$419.90
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$311.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$479.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$78.55
|
|
|
HCHG PELVIS JUDET, MIN 3 VIEWS
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
H3200624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$479.18 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$321.10
|
| Rate for Payer: Cash Price |
$321.10
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$419.90
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$311.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$251.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$479.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$78.55
|
|
|
HCHG PELVIS JUDET, MIN 3 VIEWS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 72190
|
| Hospital Charge Code |
H3200624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$419.90 |
| Max. Negotiated Rate |
$479.18 |
| Rate for Payer: Cash Price |
$321.10
|
| Rate for Payer: Health Management Network Commercial |
$419.90
|
| Rate for Payer: MDX Hawaii PPO |
$479.18
|
|
|
HCHG PELVIS MRI WO CONTR
|
Facility
|
IP
|
$2,141.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
H6120116
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,819.85 |
| Max. Negotiated Rate |
$2,076.77 |
| Rate for Payer: Cash Price |
$1,391.65
|
| Rate for Payer: Health Management Network Commercial |
$1,819.85
|
| Rate for Payer: MDX Hawaii PPO |
$2,076.77
|
|
|
HCHG PELVIS MRI WO CONTR
|
Facility
|
OP
|
$2,141.00
|
|
|
Service Code
|
HCPCS 72195
|
| Hospital Charge Code |
H6120116
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$2,076.77 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$1,391.65
|
| Rate for Payer: Cash Price |
$1,391.65
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$319.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$398.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$1,819.85
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,348.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,091.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$2,076.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$319.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$846.97
|
|
|
HCHG PELVIS MRI W/WO CONTR
|
Facility
|
OP
|
$3,102.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
H6120114
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$3,008.94 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$2,016.30
|
| Rate for Payer: Cash Price |
$2,016.30
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$709.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$882.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$2,636.70
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,954.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,582.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$3,008.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$709.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,294.91
|
|
|
HCHG PELVIS MRI W/WO CONTR
|
Facility
|
IP
|
$3,102.00
|
|
|
Service Code
|
HCPCS 72197
|
| Hospital Charge Code |
H6120114
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$2,636.70 |
| Max. Negotiated Rate |
$3,008.94 |
| Rate for Payer: Cash Price |
$2,016.30
|
| Rate for Payer: Health Management Network Commercial |
$2,636.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,008.94
|
|
|
HCHG PEP MASK INIT
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4120320
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
