|
HCHG TROPONIN T
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
H3011614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$12.47
|
| Rate for Payer: AlohaCare Medicare |
$12.47
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$13.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$12.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.47
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.47
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HCHG TRT DISTAL TIBIA FRACTURE W MANIP
|
Facility
|
IP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
H4500957
|
|
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 TRT DISTAL TIBIA FRACTURE W MANIP
|
Facility
|
OP
|
$4,705.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
H4500957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| 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 |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| 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 TRT TARSAL JOINT DISLOCATION
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
H4500962
|
|
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 TRT TARSAL JOINT DISLOCATION
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
H4500962
|
|
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 TRYPTASE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG TRYPTASE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: AlohaCare Medicaid |
$17.27
|
| Rate for Payer: AlohaCare Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$19.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.27
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.27
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG TSH
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$241.40 |
| Max. Negotiated Rate |
$275.48 |
| Rate for Payer: Cash Price |
$184.60
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: MDX Hawaii PPO |
$275.48
|
|
|
HCHG TSH
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$241.40 |
| Max. Negotiated Rate |
$275.48 |
| Rate for Payer: Cash Price |
$184.60
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: MDX Hawaii PPO |
$275.48
|
|
|
HCHG TSH
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011254
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$275.48 |
| Rate for Payer: AlohaCare Medicaid |
$16.80
|
| Rate for Payer: AlohaCare Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$184.60
|
| Rate for Payer: Cash Price |
$184.60
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.80
|
| Rate for Payer: MDX Hawaii PPO |
$275.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.80
|
| Rate for Payer: University Health Alliance Commercial |
$43.42
|
|
|
HCHG TSH
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
H3011593
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$275.48 |
| Rate for Payer: AlohaCare Medicaid |
$16.80
|
| Rate for Payer: AlohaCare Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$184.60
|
| Rate for Payer: Cash Price |
$184.60
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$241.40
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$178.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.80
|
| Rate for Payer: MDX Hawaii PPO |
$275.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.80
|
| Rate for Payer: University Health Alliance Commercial |
$43.42
|
|
|
HCHG T-SPINE 2 VIEWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200842
|
|
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
|
|
|
HCHG T-SPINE 2 VIEWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200842
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.34 |
| 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 |
$21.34
|
| 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 |
$23.43
|
| 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 |
$21.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$70.43
|
|
|
HCHG T-SPINE 2 VIEWS PORT
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200844
|
|
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
|
|
|
HCHG T-SPINE 2 VIEWS PORT
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 72070
|
| Hospital Charge Code |
H3200844
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.34 |
| 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 |
$21.34
|
| 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 |
$23.43
|
| 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 |
$21.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$70.43
|
|
|
HCHG T-SPINE 3 VIEWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
H3200788
|
|
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
|
|
|
HCHG T-SPINE 3 VIEWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 72072
|
| Hospital Charge Code |
H3200788
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| 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 |
$24.39
|
| 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 |
$26.81
|
| 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 |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$78.96
|
|
|
HCHG T-SPINE MRI WO CONTR
|
Facility
|
IP
|
$2,141.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
H6120118
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,819.85 |
| Max. Negotiated Rate |
$2,076.77 |
| Rate for Payer: Cash Price |
$1,391.65
|
| Rate for Payer: Health Management Network Commercial |
$1,819.85
|
| Rate for Payer: MDX Hawaii PPO |
$2,076.77
|
|
|
HCHG T-SPINE MRI WO CONTR
|
Facility
|
OP
|
$2,141.00
|
|
|
Service Code
|
HCPCS 72146
|
| Hospital Charge Code |
H6120118
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$281.87 |
| Max. Negotiated Rate |
$2,076.77 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$1,391.65
|
| Rate for Payer: Cash Price |
$1,391.65
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$409.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$445.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$1,819.85
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,348.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,091.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$2,076.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$409.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$855.88
|
|
|
HCHG T-SPINE MRI W/WO CONTR
|
Facility
|
OP
|
$3,381.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
H6120120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$412.14 |
| Max. Negotiated Rate |
$3,279.57 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$2,197.65
|
| Rate for Payer: Cash Price |
$2,197.65
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$819.66
|
| 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 |
$882.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$2,873.85
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,130.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,724.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$3,279.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$819.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,315.18
|
|
|
HCHG T-SPINE MRI W/WO CONTR
|
Facility
|
IP
|
$3,381.00
|
|
|
Service Code
|
HCPCS 72157
|
| Hospital Charge Code |
H6120120
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,873.85 |
| Max. Negotiated Rate |
$3,279.57 |
| Rate for Payer: Cash Price |
$2,197.65
|
| Rate for Payer: Health Management Network Commercial |
$2,873.85
|
| Rate for Payer: MDX Hawaii PPO |
$3,279.57
|
|
|
HCHG TTE CONG ABN COMPLETE W/ CONTRAST
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
H4800225
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: AlohaCare Medicaid |
$645.50
|
| Rate for Payer: AlohaCare Medicare |
$645.50
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Devoted Health Medicare |
$710.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$806.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$645.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,759.75
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Humana Medicare |
$645.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,830.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,481.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$645.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$645.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$645.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,117.45
|
|
|
HCHG TTE CONG ABN COMPLETE W/ CONTRAST
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
H4800225
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,469.25 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
|
|
HCHG TTE CONG ABN COMPLETE W/O CONTRAST
|
Facility
|
OP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
H4800224
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: AlohaCare Medicaid |
$645.50
|
| Rate for Payer: AlohaCare Medicare |
$645.50
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Devoted Health Medicare |
$710.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$806.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$645.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,888.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Humana Medicare |
$645.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,915.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,550.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$645.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$645.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$645.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,215.86
|
|
|
HCHG TTE CONG ABN COMPLETE W/O CONTRAST
|
Facility
|
IP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
H4800224
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,584.00 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
|
