|
HCHG UA MICRO REFLEX CULT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
K3070004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
|
|
HCHG UA QUAL AUTO WO MICRO
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
K3070002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
|
|
HCHG UA QUAL AUTO WO MICRO
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
K3070002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: AlohaCare Medicaid |
$2.25
|
| Rate for Payer: AlohaCare Medicare |
$2.25
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Devoted Health Medicare |
$2.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Humana Medicare |
$2.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.25
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.25
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HCHG UGI TRACT DOUBLE CONTRAST
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
H3201004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$892.50
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$661.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$535.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$1,018.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$237.13
|
|
|
HCHG UGI TRACT DOUBLE CONTRAST
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
H3201004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Health Management Network Commercial |
$892.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,018.50
|
|
|
HCHG UGI TRACT SINGLE CONTRAST
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
H3201003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$818.55 |
| Max. Negotiated Rate |
$934.11 |
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Health Management Network Commercial |
$818.55
|
| Rate for Payer: MDX Hawaii PPO |
$934.11
|
|
|
HCHG UGI TRACT SINGLE CONTRAST
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
HCPCS 74240
|
| Hospital Charge Code |
H3201003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$934.11 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Cash Price |
$625.95
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$818.55
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$491.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$934.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$208.88
|
|
|
HCHG UGT1A1 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 81350
|
| Hospital Charge Code |
K3100011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$1,121.32 |
| Rate for Payer: AlohaCare Medicaid |
$234.00
|
| Rate for Payer: AlohaCare Medicare |
$234.00
|
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Devoted Health Medicare |
$257.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$292.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.00
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Humana Medicare |
$234.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$728.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$589.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,121.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.00
|
| Rate for Payer: University Health Alliance Commercial |
$842.61
|
|
|
HCHG UGT1A1 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 81350
|
| Hospital Charge Code |
K3100011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$982.60 |
| Max. Negotiated Rate |
$1,121.32 |
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,121.32
|
|
|
HCHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 76983
|
| Hospital Charge Code |
H4020306
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$226.95 |
| Max. Negotiated Rate |
$258.99 |
| Rate for Payer: Cash Price |
$173.55
|
| Rate for Payer: Health Management Network Commercial |
$226.95
|
| Rate for Payer: MDX Hawaii PPO |
$258.99
|
|
|
HCHG ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 76983
|
| Hospital Charge Code |
H4020306
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$258.99 |
| Rate for Payer: Cash Price |
$173.55
|
| Rate for Payer: Cash Price |
$173.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$253.65
|
| Rate for Payer: Health Management Network Commercial |
$226.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.17
|
| Rate for Payer: MDX Hawaii PPO |
$258.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.50
|
| Rate for Payer: University Health Alliance Commercial |
$121.69
|
|
|
HCHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS 76982
|
| Hospital Charge Code |
H4020305
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$584.91 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.22
|
| 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 |
$63.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$379.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$307.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$584.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$200.35
|
|
|
HCHG ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS 76982
|
| Hospital Charge Code |
H4020305
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$512.55 |
| Max. Negotiated Rate |
$584.91 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: MDX Hawaii PPO |
$584.91
|
|
|
HCHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
H4020304
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$584.91 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.16
|
| 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 |
$73.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$379.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$307.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$584.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$225.11
|
|
|
HCHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
HCPCS 76981
|
| Hospital Charge Code |
H4020304
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$512.55 |
| Max. Negotiated Rate |
$584.91 |
| Rate for Payer: Cash Price |
$391.95
|
| Rate for Payer: Health Management Network Commercial |
$512.55
|
| Rate for Payer: MDX Hawaii PPO |
$584.91
|
|
|
HCHG UNLISTED MICROBIOLOGY PROCEDURE - 90
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 87999
|
| Hospital Charge Code |
H3060770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
|
|
HCHG UNLISTED MICROBIOLOGY PROCEDURE - 90
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 87999
|
| Hospital Charge Code |
H3060770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$303.05
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.69
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.90
|
| Rate for Payer: University Health Alliance Commercial |
$232.52
|
|
|
HCHG UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
H4501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$279.80
|
| Rate for Payer: AlohaCare Medicare |
$279.80
|
| Rate for Payer: Cash Price |
$935.35
|
| Rate for Payer: Cash Price |
$935.35
|
| Rate for Payer: Cash Price |
$935.35
|
| Rate for Payer: Cash Price |
$935.35
|
| Rate for Payer: Devoted Health Medicare |
$307.78
|
| 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 |
$279.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,367.05
|
| Rate for Payer: Health Management Network Commercial |
$1,223.15
|
| Rate for Payer: Humana Medicare |
$279.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$906.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,395.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.80
|
| Rate for Payer: University Health Alliance Commercial |
$1,048.89
|
|
|
HCHG UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
H4501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,223.15 |
| Max. Negotiated Rate |
$1,395.83 |
| Rate for Payer: Cash Price |
$935.35
|
| Rate for Payer: Health Management Network Commercial |
$1,223.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,395.83
|
|
|
HCHG UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
HCPCS 42999
|
| Hospital Charge Code |
K4500007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,173.85 |
| Max. Negotiated Rate |
$1,339.57 |
| Rate for Payer: Cash Price |
$897.65
|
| Rate for Payer: Health Management Network Commercial |
$1,173.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,339.57
|
|
|
HCHG UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
HCPCS 42999
|
| Hospital Charge Code |
K4500007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$279.80
|
| Rate for Payer: AlohaCare Medicare |
$279.80
|
| Rate for Payer: Cash Price |
$897.65
|
| Rate for Payer: Cash Price |
$897.65
|
| Rate for Payer: Cash Price |
$897.65
|
| Rate for Payer: Cash Price |
$897.65
|
| Rate for Payer: Devoted Health Medicare |
$307.78
|
| 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 |
$279.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,311.95
|
| Rate for Payer: Health Management Network Commercial |
$1,173.85
|
| Rate for Payer: Humana Medicare |
$279.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$870.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,339.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.80
|
| Rate for Payer: University Health Alliance Commercial |
$1,006.61
|
|
|
HCHG UPPER GI ENDOSCOPY W BIOPSY
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
H4501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.46
|
| Rate for Payer: AlohaCare Medicare |
$1,071.46
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$1,178.61
|
| 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 |
$1,071.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$1,071.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,857.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.46
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,178.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.46
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG UPPER GI ENDOSCOPY W BIOPSY
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
H4501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG UPP GI ENDO W REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
H4501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG UPP GI ENDO W REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
H4501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,183.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,071.46
|
| Rate for Payer: AlohaCare Medicare |
$1,071.46
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$1,178.61
|
| 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 |
$1,071.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$1,071.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,857.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.46
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,178.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.46
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
