|
HCHG RESP MOTION MGMT-PHYSICS
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
H3330239
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,426.30 |
| Max. Negotiated Rate |
$1,627.66 |
| Rate for Payer: Cash Price |
$1,090.70
|
| Rate for Payer: Health Management Network Commercial |
$1,426.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,627.66
|
|
|
HCHG RESP VIRUS 6-11 TARGETS - 90
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 87632
|
| Hospital Charge Code |
H3060804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$997.05 |
| Max. Negotiated Rate |
$1,137.81 |
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Health Management Network Commercial |
$997.05
|
| Rate for Payer: MDX Hawaii PPO |
$1,137.81
|
|
|
HCHG RESP VIRUS 6-11 TARGETS - 90
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 87632
|
| Hospital Charge Code |
H3060804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$176.02 |
| Max. Negotiated Rate |
$1,137.81 |
| Rate for Payer: AlohaCare Medicaid |
$218.06
|
| Rate for Payer: AlohaCare Medicare |
$218.06
|
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Cash Price |
$762.45
|
| Rate for Payer: Devoted Health Medicare |
$239.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$290.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$272.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$218.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$298.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$218.06
|
| Rate for Payer: Health Management Network Commercial |
$997.05
|
| Rate for Payer: Humana Medicare |
$218.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$738.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$598.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.06
|
| Rate for Payer: MDX Hawaii PPO |
$1,137.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$218.06
|
| Rate for Payer: University Health Alliance Commercial |
$855.00
|
|
|
HCHG RETIC COUNT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
H3050246
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
HCHG RETIC COUNT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
H3050246
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$3.99
|
| Rate for Payer: AlohaCare Medicare |
$3.99
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Devoted Health Medicare |
$4.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.99
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$3.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.99
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.99
|
| Rate for Payer: University Health Alliance Commercial |
$10.34
|
|
|
HCHG RETROGRADE URETHROGRAM
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.28 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.28
|
| 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 |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,083.75
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$650.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$1,236.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$159.90
|
|
|
HCHG RETROGRADE URETHROGRAM
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Health Management Network Commercial |
$1,083.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,236.75
|
|
|
HCHG RETRO PYELOGRAM PORT
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200700
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.28 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.28
|
| 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 |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,083.75
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$803.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$650.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$1,236.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$159.90
|
|
|
HCHG RETRO PYELOGRAM PORT
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
H3200700
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,083.75 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Cash Price |
$828.75
|
| Rate for Payer: Health Management Network Commercial |
$1,083.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,236.75
|
|
|
HCHG RHEUMATOID FACTOR QUANT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$5.67
|
| Rate for Payer: AlohaCare Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| 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 |
$83.30
|
| Rate for Payer: Humana Medicare |
$5.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.67
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| 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 RHEUMATOID FACTOR QUANT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 86431
|
| Hospital Charge Code |
H3020750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
HCHG RH FACTOR
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020746
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$2.99
|
| Rate for Payer: AlohaCare Medicare |
$2.99
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$3.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$2.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.99
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.99
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HCHG RH FACTOR
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
H3020746
|
|
Hospital Revenue Code
|
302
|
| 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 RHO IG FULL DOSE (00562-7805-01)
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
H2700803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$441.35 |
| Rate for Payer: Cash Price |
$295.75
|
| Rate for Payer: Health Management Network Commercial |
$386.75
|
| Rate for Payer: MDX Hawaii PPO |
$441.35
|
|
|
HCHG RHO IG FULL DOSE (00562-7805-01)
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
H2700803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$441.35 |
| Rate for Payer: Cash Price |
$295.75
|
| Rate for Payer: Cash Price |
$295.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$432.25
|
| Rate for Payer: Health Management Network Commercial |
$386.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.05
|
| Rate for Payer: MDX Hawaii PPO |
$441.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$273.00
|
| Rate for Payer: University Health Alliance Commercial |
$331.65
|
|
|
HCHG RH PHENOTYPE COMP
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 86906
|
| Hospital Charge Code |
H3020748
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$153.26 |
| Rate for Payer: AlohaCare Medicaid |
$7.75
|
| Rate for Payer: AlohaCare Medicare |
$7.75
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Devoted Health Medicare |
$8.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.75
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Humana Medicare |
$7.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.75
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.75
|
| Rate for Payer: University Health Alliance Commercial |
$20.04
|
|
|
HCHG RH PHENOTYPE COMP
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 86906
|
| Hospital Charge Code |
H3020748
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$153.26 |
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
|
|
HCHG RHYTHM STRIP EXTEND, TRACING ONLY
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
H7300116
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
|
|
HCHG RHYTHM STRIP EXTEND, TRACING ONLY
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
H7300116
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AlohaCare Medicaid |
$69.69
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| 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 |
$190.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Humana Medicare |
$69.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.69
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
| Rate for Payer: University Health Alliance Commercial |
$145.78
|
|
|
HCHG RIBS BIL W CHEST MIN 4VW
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
H3200710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$632.40 |
| Max. Negotiated Rate |
$721.68 |
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: MDX Hawaii PPO |
$721.68
|
|
|
HCHG RIBS BIL W CHEST MIN 4VW
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 71111
|
| Hospital Charge Code |
H3200710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$721.68 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Cash Price |
$483.60
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| 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 |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$632.40
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$379.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$721.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$105.84
|
|
|
HCHG RIBS UNILAT 2 VIEWS
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
H3200918
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$532.53 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| 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 |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$466.65
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$345.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$279.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$532.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$66.43
|
|
|
HCHG RIBS UNILAT 2 VIEWS
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
HCPCS 71100
|
| Hospital Charge Code |
H3200918
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$466.65 |
| Max. Negotiated Rate |
$532.53 |
| Rate for Payer: Cash Price |
$356.85
|
| Rate for Payer: Health Management Network Commercial |
$466.65
|
| Rate for Payer: MDX Hawaii PPO |
$532.53
|
|
|
HCHG RIBS UNI W CHEST MIN 3 VIEWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
H3200714
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Cash Price |
$372.45
|
| 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 |
$487.05
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
| 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 |
$80.36
|
|
|
HCHG RIBS UNI W CHEST MIN 3 VIEWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 71101
|
| Hospital Charge Code |
H3200714
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$487.05 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
|
