|
HCHG SHOULDER ARTHROGRAM *
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
H3200744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.25 |
| Max. Negotiated Rate |
$1,972.98 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Cash Price |
$1,322.10
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$69.25
|
| 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 |
$75.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,728.90
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,281.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,037.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$1,972.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$222.87
|
|
|
HCHG SHOULDER MIN 2 VIEWS
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.85 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Health Management Network Commercial |
$493.85
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
|
|
HCHG SHOULDER MIN 2 VIEWS
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Cash Price |
$377.65
|
| 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 |
$493.85
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$296.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
| 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 |
$61.92
|
|
|
HCHG SHOULDER MIN 2 VIEWS PORT
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200750
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Cash Price |
$377.65
|
| 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 |
$493.85
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$366.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$296.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
| 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 |
$61.92
|
|
|
HCHG SHOULDER MIN 2 VIEWS PORT
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200750
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.85 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Health Management Network Commercial |
$493.85
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
|
|
HCHG SICKLE CELL SCRN 90
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
H3050250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HCHG SICKLE CELL SCRN 90
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
H3050250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$5.51
|
| Rate for Payer: AlohaCare Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Devoted Health Medicare |
$6.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$5.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.51
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.51
|
| Rate for Payer: University Health Alliance Commercial |
$14.26
|
|
|
HCHG SIMP SPIROMETRY
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
H4600146
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$582.97 |
| Rate for Payer: Cash Price |
$390.65
|
| Rate for Payer: Health Management Network Commercial |
$510.85
|
| Rate for Payer: MDX Hawaii PPO |
$582.97
|
|
|
HCHG SIMP SPIROMETRY
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
H4600146
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$582.97 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$390.65
|
| Rate for Payer: Cash Price |
$390.65
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$570.95
|
| Rate for Payer: Health Management Network Commercial |
$510.85
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$378.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$306.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$582.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$438.07
|
|
|
HCHG SIMULATION COMPLX
|
Facility
|
OP
|
$2,079.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
H3330170
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$214.62 |
| Max. Negotiated Rate |
$2,016.63 |
| Rate for Payer: AlohaCare Medicaid |
$442.33
|
| Rate for Payer: AlohaCare Medicare |
$442.33
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Devoted Health Medicare |
$486.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$214.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$552.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$233.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$442.33
|
| Rate for Payer: Health Management Network Commercial |
$1,767.15
|
| Rate for Payer: Humana Medicare |
$442.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,309.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,060.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.33
|
| Rate for Payer: MDX Hawaii PPO |
$2,016.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$214.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.33
|
| Rate for Payer: University Health Alliance Commercial |
$937.39
|
|
|
HCHG SIMULATION COMPLX
|
Facility
|
IP
|
$2,079.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
H3330170
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,767.15 |
| Max. Negotiated Rate |
$2,016.63 |
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Health Management Network Commercial |
$1,767.15
|
| Rate for Payer: MDX Hawaii PPO |
$2,016.63
|
|
|
HCHG SIMULATION SIMP
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
H3330174
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
|
|
HCHG SIMULATION SIMP
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
H3330174
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.62 |
| Max. Negotiated Rate |
$882.70 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$128.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$773.50
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$573.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$464.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$882.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$122.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$381.04
|
|
|
HCHG SINUSES < 3 VIEWS
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
H3200610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$353.08 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| 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 |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$185.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$353.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$62.81
|
|
|
HCHG SINUSES < 3 VIEWS
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
HCPCS 70210
|
| Hospital Charge Code |
H3200610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$309.40 |
| Max. Negotiated Rate |
$353.08 |
| Rate for Payer: Cash Price |
$236.60
|
| Rate for Payer: Health Management Network Commercial |
$309.40
|
| Rate for Payer: MDX Hawaii PPO |
$353.08
|
|
|
HCHG SINUSES MIN 3 VIEWS
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
H3200608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$484.50 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: MDX Hawaii PPO |
$552.90
|
|
|
HCHG SINUSES MIN 3 VIEWS
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 70220
|
| Hospital Charge Code |
H3200608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Cash Price |
$370.50
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.96
|
| 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 |
$28.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$359.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$552.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$82.68
|
|
|
HCHG SIROLIMUS, WHOLE BLOOD - 90
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
H3011752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: AlohaCare Medicaid |
$13.73
|
| Rate for Payer: AlohaCare Medicare |
$13.73
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$15.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.73
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$13.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.73
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.73
|
| Rate for Payer: University Health Alliance Commercial |
$35.46
|
|
|
HCHG SIROLIMUS, WHOLE BLOOD - 90
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 80195
|
| Hospital Charge Code |
H3011752
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
HCHG SJOGRENS AB
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
K3020004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HCHG SJOGRENS AB
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
K3020004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HCHG SJOGREN'S AB SSA 90
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HCHG SJOGREN'S AB SSA 90
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HCHG SJOGREN'S AB SSB 90
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HCHG SJOGREN'S AB SSB 90
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
