|
HCHG TRANSABDOM AMNIOINFUS W/US
|
Facility
|
OP
|
$1,509.00
|
|
|
Service Code
|
HCPCS 59070
|
| Hospital Charge Code |
K7210008
|
|
Hospital Revenue Code
|
721
|
| Min. Negotiated Rate |
$301.72 |
| Max. Negotiated Rate |
$1,463.73 |
| Rate for Payer: AlohaCare Medicaid |
$359.99
|
| Rate for Payer: AlohaCare Medicare |
$359.99
|
| Rate for Payer: Cash Price |
$980.85
|
| Rate for Payer: Cash Price |
$980.85
|
| Rate for Payer: Devoted Health Medicare |
$395.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$449.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$359.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,433.55
|
| Rate for Payer: Health Management Network Commercial |
$1,282.65
|
| Rate for Payer: Humana Medicare |
$359.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$950.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$769.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$359.99
|
| Rate for Payer: MDX Hawaii PPO |
$1,463.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$359.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$301.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$359.99
|
| Rate for Payer: University Health Alliance Commercial |
$1,099.91
|
|
|
HCHG TRANSCUTANEOUS MONITORING
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
H4600187
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Kaiser Permanente Commercial |
$585.90
|
| Rate for Payer: AlohaCare Medicaid |
$152.01
|
| Rate for Payer: AlohaCare Medicare |
$152.01
|
| Rate for Payer: Cash Price |
$604.50
|
| Rate for Payer: Cash Price |
$604.50
|
| Rate for Payer: Devoted Health Medicare |
$167.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$190.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$883.50
|
| Rate for Payer: Health Management Network Commercial |
$790.50
|
| Rate for Payer: Humana Medicare |
$152.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$474.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.01
|
| Rate for Payer: MDX Hawaii PPO |
$902.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.01
|
| Rate for Payer: University Health Alliance Commercial |
$677.88
|
|
|
HCHG TRANSCUTANEOUS MONITORING
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
H4600187
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$790.50 |
| Max. Negotiated Rate |
$902.10 |
| Rate for Payer: Cash Price |
$604.50
|
| Rate for Payer: Health Management Network Commercial |
$790.50
|
| Rate for Payer: MDX Hawaii PPO |
$902.10
|
|
|
HCHG TRANSFERRIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
H3011238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$12.76
|
| Rate for Payer: AlohaCare Medicare |
$12.76
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$14.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.76
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$12.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.76
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.76
|
| Rate for Payer: University Health Alliance Commercial |
$33.00
|
|
|
HCHG TRANSFERRIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 84466
|
| Hospital Charge Code |
H3011238
|
|
Hospital Revenue Code
|
301
|
| 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 TRANSFUSION BLD/BLD COMPON
|
Facility
|
IP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H4500826
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1,785.85 |
| Max. Negotiated Rate |
$2,037.97 |
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Health Management Network Commercial |
$1,785.85
|
| Rate for Payer: MDX Hawaii PPO |
$2,037.97
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
OP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H3910113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$2,833.00 |
| Rate for Payer: AlohaCare Medicaid |
$521.18
|
| Rate for Payer: AlohaCare Medicare |
$521.18
|
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Devoted Health Medicare |
$573.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$521.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,995.95
|
| Rate for Payer: Health Management Network Commercial |
$1,785.85
|
| Rate for Payer: Humana Medicare |
$521.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,323.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,071.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$521.18
|
| Rate for Payer: MDX Hawaii PPO |
$2,037.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$573.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$521.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$521.18
|
| Rate for Payer: University Health Alliance Commercial |
$1,531.42
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
OP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H4500826
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$2,833.00 |
| Rate for Payer: AlohaCare Medicaid |
$521.18
|
| Rate for Payer: AlohaCare Medicare |
$521.18
|
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Devoted Health Medicare |
$573.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$521.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,995.95
|
| Rate for Payer: Health Management Network Commercial |
$1,785.85
|
| Rate for Payer: Humana Medicare |
$521.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,323.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,071.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$521.18
|
| Rate for Payer: MDX Hawaii PPO |
$2,037.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$573.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$521.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$521.18
|
| Rate for Payer: University Health Alliance Commercial |
$1,531.42
|
|
|
HCHG TRANSFUSION BLD/BLD COMPON
|
Facility
|
IP
|
$2,101.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
H3910113
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$1,785.85 |
| Max. Negotiated Rate |
$2,037.97 |
| Rate for Payer: Cash Price |
$1,365.65
|
| Rate for Payer: Health Management Network Commercial |
$1,785.85
|
| Rate for Payer: MDX Hawaii PPO |
$2,037.97
|
|
|
HCHG TRANSFUSION REACTION WORKUP
|
Facility
|
OP
|
$1,078.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
H3020794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$1,045.66 |
| Rate for Payer: AlohaCare Medicaid |
$201.27
|
| Rate for Payer: AlohaCare Medicare |
$201.27
|
| Rate for Payer: Cash Price |
$700.70
|
| Rate for Payer: Cash Price |
$700.70
|
| Rate for Payer: Devoted Health Medicare |
$221.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.27
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: Humana Medicare |
$201.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$679.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$549.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,045.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.27
|
| Rate for Payer: University Health Alliance Commercial |
$93.72
|
|
|
HCHG TRANSFUSION REACTION WORKUP
|
Facility
|
IP
|
$1,078.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
H3020794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$916.30 |
| Max. Negotiated Rate |
$1,045.66 |
| Rate for Payer: Cash Price |
$700.70
|
| Rate for Payer: Health Management Network Commercial |
$916.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,045.66
|
|
|
HCHG TRAUMA EVALUATION W/ CC
|
Facility
|
IP
|
$5,005.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
K6830003
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$4,254.25 |
| Max. Negotiated Rate |
$4,854.85 |
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Health Management Network Commercial |
$4,254.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,854.85
|
|
|
HCHG TRAUMA EVALUATION W/ CC
|
Facility
|
OP
|
$5,005.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
K6830003
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$992.38 |
| Max. Negotiated Rate |
$4,854.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,574.63
|
| Rate for Payer: AlohaCare Medicare |
$1,574.63
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Cash Price |
$3,253.25
|
| Rate for Payer: Devoted Health Medicare |
$1,732.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,968.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,574.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,754.75
|
| Rate for Payer: Health Management Network Commercial |
$4,254.25
|
| Rate for Payer: Humana Medicare |
$1,574.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,153.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,552.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,574.63
|
| Rate for Payer: MDX Hawaii PPO |
$4,854.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,732.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,574.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$992.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,574.63
|
| Rate for Payer: University Health Alliance Commercial |
$3,648.14
|
|
|
HCHG TRAUMA EVALUATION W/O CC
|
Facility
|
OP
|
$3,429.00
|
|
| Hospital Charge Code |
K6830004
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$1,748.79 |
| Max. Negotiated Rate |
$3,326.13 |
| Rate for Payer: Cash Price |
$2,228.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,257.55
|
| Rate for Payer: Health Management Network Commercial |
$2,914.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,160.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,748.79
|
| Rate for Payer: MDX Hawaii PPO |
$3,326.13
|
| Rate for Payer: University Health Alliance Commercial |
$2,499.40
|
|
|
HCHG TRAUMA EVALUATION W/O CC
|
Facility
|
IP
|
$3,429.00
|
|
| Hospital Charge Code |
K6830004
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$2,914.65 |
| Max. Negotiated Rate |
$3,326.13 |
| Rate for Payer: Cash Price |
$2,228.85
|
| Rate for Payer: Health Management Network Commercial |
$2,914.65
|
| Rate for Payer: MDX Hawaii PPO |
$3,326.13
|
|
|
HCHG TREADMILL EXAM
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
H4820102
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,514.17 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$1,014.65
|
| Rate for Payer: Cash Price |
$1,014.65
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,482.95
|
| Rate for Payer: Health Management Network Commercial |
$1,326.85
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$983.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$796.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$1,514.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$1,137.81
|
|
|
HCHG TREADMILL EXAM
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
H4820102
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,326.85 |
| Max. Negotiated Rate |
$1,514.17 |
| Rate for Payer: Cash Price |
$1,014.65
|
| Rate for Payer: Health Management Network Commercial |
$1,326.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,514.17
|
|
|
HCHG TREAT ELBOW DISLOCATION W/ANES
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
H4501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,833.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,964.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG TREAT ELBOW DISLOCATION W/ANES
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
H4501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27256
|
| Hospital Charge Code |
H4500950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 27256
|
| Hospital Charge Code |
H4500950
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.40 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$291.40
|
| Rate for Payer: AlohaCare Medicare |
$291.40
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$320.54
|
| 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 |
$291.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$291.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$907.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$291.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$320.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$291.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$291.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG TREAT HUMERUS TUBEROSITY FRACTURE W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
H4500937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| 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 |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,469.75
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,964.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,089.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,899.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,899.59
|
| Rate for Payer: University Health Alliance Commercial |
$3,429.47
|
|
|
HCHG TREAT HUMERUS TUBEROSITY FRACTURE W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
H4500937
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,999.25 |
| Max. Negotiated Rate |
$4,563.85 |
| Rate for Payer: Cash Price |
$3,058.25
|
| Rate for Payer: Health Management Network Commercial |
$3,999.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,563.85
|
|
|
HCHG TREATMENT DEVICE COMPLEX
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
H3330196
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$114.46 |
| Max. Negotiated Rate |
$1,594.68 |
| Rate for Payer: AlohaCare Medicaid |
$442.33
|
| Rate for Payer: AlohaCare Medicare |
$442.33
|
| Rate for Payer: Cash Price |
$1,068.60
|
| Rate for Payer: Cash Price |
$1,068.60
|
| Rate for Payer: Devoted Health Medicare |
$486.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.46
|
| 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 |
$120.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$442.33
|
| Rate for Payer: Health Management Network Commercial |
$1,397.40
|
| Rate for Payer: Humana Medicare |
$442.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,035.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$838.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.33
|
| Rate for Payer: MDX Hawaii PPO |
$1,594.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.33
|
| Rate for Payer: University Health Alliance Commercial |
$343.42
|
|
|
HCHG TREATMENT DEVICE COMPLEX
|
Facility
|
IP
|
$1,644.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
H3330196
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,397.40 |
| Max. Negotiated Rate |
$1,594.68 |
| Rate for Payer: Cash Price |
$1,068.60
|
| Rate for Payer: Health Management Network Commercial |
$1,397.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,594.68
|
|
