|
HCHG RADIOLOGIC EXAM RIBS 3VW BILAT
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
H3200939
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| 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 |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$85.69
|
|
|
HCHG RADIOLOGIC EXAM RIBS 3VW BILAT
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
HCPCS 71110
|
| Hospital Charge Code |
H3200939
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$441.15 |
| Max. Negotiated Rate |
$503.43 |
| Rate for Payer: Cash Price |
$337.35
|
| Rate for Payer: Health Management Network Commercial |
$441.15
|
| Rate for Payer: MDX Hawaii PPO |
$503.43
|
|
|
HCHG RADIOLOGIC EXAM SPINE, LUMB COMP, INCL BENDING VIEWS
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
H3200959
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$727.50 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.30
|
| 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 |
$42.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$637.50
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$472.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$382.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$727.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$141.23
|
|
|
HCHG RADIOLOGIC EXAM SPINE, LUMB COMP, INCL BENDING VIEWS
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 72114
|
| Hospital Charge Code |
H3200959
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$727.50 |
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Health Management Network Commercial |
$637.50
|
| Rate for Payer: MDX Hawaii PPO |
$727.50
|
|
|
HCHG RADIOPHARM THERAPY, ORAL
|
Facility
|
OP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
H3420133
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$82.79 |
| Max. Negotiated Rate |
$1,500.59 |
| Rate for Payer: AlohaCare Medicaid |
$275.65
|
| Rate for Payer: AlohaCare Medicare |
$275.65
|
| Rate for Payer: Cash Price |
$1,005.55
|
| Rate for Payer: Cash Price |
$1,005.55
|
| Rate for Payer: Devoted Health Medicare |
$303.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$344.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.65
|
| Rate for Payer: Health Management Network Commercial |
$1,314.95
|
| Rate for Payer: Humana Medicare |
$275.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$974.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$788.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,500.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$303.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.65
|
| Rate for Payer: University Health Alliance Commercial |
$326.89
|
|
|
HCHG RADIOPHARM THERAPY, ORAL
|
Facility
|
IP
|
$1,547.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
H3420133
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,314.95 |
| Max. Negotiated Rate |
$1,500.59 |
| Rate for Payer: Cash Price |
$1,005.55
|
| Rate for Payer: Health Management Network Commercial |
$1,314.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,500.59
|
|
|
HCHG RAD THER CMPLX >1
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
H3330230
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$1,116.47 |
| Rate for Payer: AlohaCare Medicaid |
$652.74
|
| Rate for Payer: AlohaCare Medicare |
$652.74
|
| Rate for Payer: Cash Price |
$748.15
|
| Rate for Payer: Cash Price |
$748.15
|
| Rate for Payer: Devoted Health Medicare |
$718.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$76.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$815.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$652.74
|
| Rate for Payer: Health Management Network Commercial |
$978.35
|
| Rate for Payer: Humana Medicare |
$652.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$725.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$587.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$652.74
|
| Rate for Payer: MDX Hawaii PPO |
$1,116.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$718.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.74
|
| Rate for Payer: University Health Alliance Commercial |
$371.98
|
|
|
HCHG RAD THER CMPLX >1
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
H3330230
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$978.35 |
| Max. Negotiated Rate |
$1,116.47 |
| Rate for Payer: Cash Price |
$748.15
|
| Rate for Payer: Health Management Network Commercial |
$978.35
|
| Rate for Payer: MDX Hawaii PPO |
$1,116.47
|
|
|
HCHG RAD THER INTER >1
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
H3330229
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,227.40 |
| Max. Negotiated Rate |
$1,400.68 |
| Rate for Payer: Cash Price |
$938.60
|
| Rate for Payer: Health Management Network Commercial |
$1,227.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,400.68
|
|
|
HCHG RAD THER INTER >1
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
H3330229
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$1,400.68 |
| Rate for Payer: AlohaCare Medicaid |
$455.64
|
| Rate for Payer: AlohaCare Medicare |
$455.64
|
| Rate for Payer: Cash Price |
$938.60
|
| Rate for Payer: Cash Price |
$938.60
|
| Rate for Payer: Devoted Health Medicare |
$501.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$569.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$455.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$455.64
|
| Rate for Payer: Health Management Network Commercial |
$1,227.40
|
| Rate for Payer: Humana Medicare |
$455.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$909.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$736.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$455.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,400.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$501.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$455.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$455.64
|
| Rate for Payer: University Health Alliance Commercial |
$321.79
|
|
|
HCHG RAD THER SMP >1
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
H3330228
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$651.84 |
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: MDX Hawaii PPO |
$651.84
|
|
|
HCHG RAD THER SMP >1
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
H3330228
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$58.71 |
| Max. Negotiated Rate |
$651.84 |
| Rate for Payer: AlohaCare Medicaid |
$120.53
|
| Rate for Payer: AlohaCare Medicare |
$120.53
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Devoted Health Medicare |
$132.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$150.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.53
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: Humana Medicare |
$120.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$423.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$342.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.53
|
| Rate for Payer: MDX Hawaii PPO |
$651.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.53
|
| Rate for Payer: University Health Alliance Commercial |
$250.77
|
|
|
HCHG RA FACTOR-BODY FLD QUANT
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HCHG RA FACTOR-BODY FLD QUANT
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020710
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$5.67
|
| Rate for Payer: AlohaCare Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Devoted Health Medicare |
$6.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.67
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.67
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.67
|
| Rate for Payer: University Health Alliance Commercial |
$14.67
|
|
|
HCHG RAPID DIR GRP-A STREP SCREEN
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
H3060666
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: AlohaCare Medicaid |
$16.53
|
| Rate for Payer: AlohaCare Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Devoted Health Medicare |
$18.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Humana Medicare |
$16.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.53
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.53
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG RAPID DIR GRP-A STREP SCREEN
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
H3060666
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
|
|
HCHG RAPID MOLECULAR PRENATAL GBS SCREEN
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
H3060648
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| 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 |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$403.75
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$460.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG RAPID MOLECULAR PRENATAL GBS SCREEN
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
H3060648
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$403.75 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Health Management Network Commercial |
$403.75
|
| Rate for Payer: MDX Hawaii PPO |
$460.75
|
|
|
HCHG RAS/RAF PANEL SO
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
K3100008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,665.66 |
| Max. Negotiated Rate |
$3,168.02 |
| Rate for Payer: Cash Price |
$2,122.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,102.70
|
| Rate for Payer: Health Management Network Commercial |
$2,776.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,057.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,665.66
|
| Rate for Payer: MDX Hawaii PPO |
$3,168.02
|
| Rate for Payer: University Health Alliance Commercial |
$2,380.59
|
|
|
HCHG RAS/RAF PANEL SO
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
HCPCS 81479
|
| Hospital Charge Code |
K3100008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,776.10 |
| Max. Negotiated Rate |
$3,168.02 |
| Rate for Payer: Cash Price |
$2,122.90
|
| Rate for Payer: Health Management Network Commercial |
$2,776.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,168.02
|
|
|
HCHG RBC ANTIGEN 1 AG
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
H3020726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$597.55 |
| Max. Negotiated Rate |
$681.91 |
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
|
|
HCHG RBC ANTIGEN 1 AG
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
H3020726
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$681.91 |
| Rate for Payer: AlohaCare Medicaid |
$3.83
|
| Rate for Payer: AlohaCare Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Cash Price |
$456.95
|
| Rate for Payer: Devoted Health Medicare |
$4.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.83
|
| Rate for Payer: Health Management Network Commercial |
$597.55
|
| Rate for Payer: Humana Medicare |
$3.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$442.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$358.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.83
|
| Rate for Payer: MDX Hawaii PPO |
$681.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.83
|
| Rate for Payer: University Health Alliance Commercial |
$9.88
|
|
|
HCHG RBC LEUKOCYTES REDUCED EA UNIT
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
H3900253
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,025.10 |
| Max. Negotiated Rate |
$1,169.82 |
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Health Management Network Commercial |
$1,025.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,169.82
|
|
|
HCHG RBC LEUKOCYTES REDUCED EA UNIT
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
H3900253
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,169.82 |
| Rate for Payer: AlohaCare Medicaid |
$213.81
|
| Rate for Payer: AlohaCare Medicare |
$213.81
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Devoted Health Medicare |
$235.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$267.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,145.70
|
| Rate for Payer: Health Management Network Commercial |
$1,025.10
|
| Rate for Payer: Humana Medicare |
$213.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$615.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$213.81
|
| Rate for Payer: MDX Hawaii PPO |
$1,169.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.81
|
| Rate for Payer: University Health Alliance Commercial |
$879.05
|
|
|
HCHG RBC LEUKOREDUCED IRRADIATED EA UNIT
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
H3900246
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$191.85 |
| Max. Negotiated Rate |
$1,583.04 |
| Rate for Payer: AlohaCare Medicaid |
$306.89
|
| Rate for Payer: AlohaCare Medicare |
$306.89
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Devoted Health Medicare |
$337.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$383.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$306.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,550.40
|
| Rate for Payer: Health Management Network Commercial |
$1,387.20
|
| Rate for Payer: Humana Medicare |
$306.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,028.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$832.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.89
|
| Rate for Payer: MDX Hawaii PPO |
$1,583.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$337.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$191.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.89
|
| Rate for Payer: University Health Alliance Commercial |
$1,189.56
|
|
