|
HCHG THROMBOLYSIS CEREBRAL IV INF
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
H4500818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.20 |
| Max. Negotiated Rate |
$1,848.82 |
| Rate for Payer: Kaiser Permanente Commercial |
$1,200.78
|
| Rate for Payer: AlohaCare Medicaid |
$390.20
|
| Rate for Payer: AlohaCare Medicare |
$390.20
|
| Rate for Payer: Cash Price |
$1,238.90
|
| Rate for Payer: Cash Price |
$1,238.90
|
| Rate for Payer: Cash Price |
$1,238.90
|
| Rate for Payer: Cash Price |
$1,238.90
|
| Rate for Payer: Devoted Health Medicare |
$429.22
|
| 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 |
$390.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,810.70
|
| Rate for Payer: Health Management Network Commercial |
$1,620.10
|
| Rate for Payer: Humana Medicare |
$390.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$390.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,848.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$429.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$390.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$390.20
|
| Rate for Payer: University Health Alliance Commercial |
$1,389.28
|
|
|
HCHG THROMBOLYSIS CEREBRAL IV INF
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 37195
|
| Hospital Charge Code |
H4500818
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,620.10 |
| Max. Negotiated Rate |
$1,848.82 |
| Rate for Payer: Cash Price |
$1,238.90
|
| Rate for Payer: Health Management Network Commercial |
$1,620.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,848.82
|
|
|
HCHG THYROGLOBULIN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
H3011226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: AlohaCare Medicaid |
$16.06
|
| Rate for Payer: AlohaCare Medicare |
$16.06
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$17.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.06
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Humana Medicare |
$16.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.06
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.06
|
| Rate for Payer: University Health Alliance Commercial |
$41.51
|
|
|
HCHG THYROGLOBULIN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 84432
|
| Hospital Charge Code |
H3011226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
|
|
HCHG THYROID CA METS IMAGE WB
|
Facility
|
OP
|
$2,273.00
|
|
|
Service Code
|
HCPCS 78018
|
| Hospital Charge Code |
H3410192
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$2,204.81 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,477.45
|
| Rate for Payer: Cash Price |
$1,477.45
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$178.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$1,932.05
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,159.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,204.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$617.66
|
|
|
HCHG THYROID CA METS IMAGE WB
|
Facility
|
IP
|
$2,273.00
|
|
|
Service Code
|
HCPCS 78018
|
| Hospital Charge Code |
H3410192
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,932.05 |
| Max. Negotiated Rate |
$2,204.81 |
| Rate for Payer: Cash Price |
$1,477.45
|
| Rate for Payer: Health Management Network Commercial |
$1,932.05
|
| Rate for Payer: MDX Hawaii PPO |
$2,204.81
|
|
|
HCHG THYROID SCAN
|
Facility
|
OP
|
$2,133.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
H3410385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$2,069.01 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,386.45
|
| Rate for Payer: Cash Price |
$1,386.45
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| 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 |
$86.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,813.05
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,343.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,087.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,069.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$353.65
|
|
|
HCHG THYROID SCAN
|
Facility
|
IP
|
$2,133.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
H3410385
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,813.05 |
| Max. Negotiated Rate |
$2,069.01 |
| Rate for Payer: Cash Price |
$1,386.45
|
| Rate for Payer: Health Management Network Commercial |
$1,813.05
|
| Rate for Payer: MDX Hawaii PPO |
$2,069.01
|
|
|
HCHG THYROID SCAN W UPT MULT
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
H3410300
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$1,365.76 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$95.18
|
| 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 |
$92.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,196.80
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$887.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$718.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,365.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$511.34
|
|
|
HCHG THYROID SCAN W UPT MULT
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
H3410300
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,196.80 |
| Max. Negotiated Rate |
$1,365.76 |
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Health Management Network Commercial |
$1,196.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,365.76
|
|
|
HCHG THYROID SCAN W UPT SINGL
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
H3410298
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$1,365.76 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$95.18
|
| 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 |
$92.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,196.80
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$887.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$718.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,365.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$511.34
|
|
|
HCHG THYROID SCAN W UPT SINGL
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
H3410298
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,196.80 |
| Max. Negotiated Rate |
$1,365.76 |
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Health Management Network Commercial |
$1,196.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,365.76
|
|
|
HCHG THYROID STIMULATING IG 90
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
H3011228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$273.70 |
| Max. Negotiated Rate |
$312.34 |
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: MDX Hawaii PPO |
$312.34
|
|
|
HCHG THYROID STIMULATING IG 90
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 84445
|
| Hospital Charge Code |
H3011228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$312.34 |
| Rate for Payer: AlohaCare Medicaid |
$50.86
|
| Rate for Payer: AlohaCare Medicare |
$50.86
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Devoted Health Medicare |
$55.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$34.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.86
|
| Rate for Payer: Health Management Network Commercial |
$273.70
|
| Rate for Payer: Humana Medicare |
$50.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.86
|
| Rate for Payer: MDX Hawaii PPO |
$312.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.86
|
| Rate for Payer: University Health Alliance Commercial |
$61.57
|
|
|
HCHG THYROID UPT SNGL
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
H3410312
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$801.22 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$536.90
|
| Rate for Payer: Cash Price |
$536.90
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| 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 |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$702.10
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$520.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$421.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$801.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$174.82
|
|
|
HCHG THYROID UPT SNGL
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
HCPCS 78012
|
| Hospital Charge Code |
H3410312
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$702.10 |
| Max. Negotiated Rate |
$801.22 |
| Rate for Payer: Cash Price |
$536.90
|
| Rate for Payer: Health Management Network Commercial |
$702.10
|
| Rate for Payer: MDX Hawaii PPO |
$801.22
|
|
|
HCHG THYROXINE BINDING GLOBULIN 90
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
H3011230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: AlohaCare Medicaid |
$14.78
|
| Rate for Payer: AlohaCare Medicare |
$14.78
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Devoted Health Medicare |
$16.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.78
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Humana Medicare |
$14.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.78
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.78
|
| Rate for Payer: University Health Alliance Commercial |
$38.22
|
|
|
HCHG THYROXINE BINDING GLOBULIN 90
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 84442
|
| Hospital Charge Code |
H3011230
|
|
Hospital Revenue Code
|
301
|
| 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 THYROXINE FREE T4
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
H3011232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
HCHG THYROXINE FREE T4
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
H3011232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: AlohaCare Medicaid |
$9.02
|
| Rate for Payer: AlohaCare Medicare |
$9.02
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$9.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.02
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$9.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.02
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.02
|
| Rate for Payer: University Health Alliance Commercial |
$23.31
|
|
|
HCHG TIB/FIB, 2 VIEWS
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200538
|
|
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 TIB/FIB, 2 VIEWS
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200538
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| 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 |
$18.46
|
| 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 |
$19.38
|
| 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 |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
HCHG TIB/FIB PORT, 2 VIEWS
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200540
|
|
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 TIB/FIB PORT, 2 VIEWS
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
HCPCS 73590
|
| Hospital Charge Code |
H3200540
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.46 |
| 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 |
$18.46
|
| 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 |
$19.38
|
| 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 |
$18.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$56.98
|
|
|
HCHG TISS EXAM CX/LG MULT LVL V
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
H3120284
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$1,089.31 |
| Rate for Payer: AlohaCare Medicaid |
$423.45
|
| Rate for Payer: AlohaCare Medicare |
$423.45
|
| Rate for Payer: Cash Price |
$729.95
|
| Rate for Payer: Cash Price |
$729.95
|
| Rate for Payer: Devoted Health Medicare |
$465.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$529.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.45
|
| Rate for Payer: Health Management Network Commercial |
$954.55
|
| Rate for Payer: Humana Medicare |
$423.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$572.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,089.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.45
|
| Rate for Payer: University Health Alliance Commercial |
$408.52
|
|
