|
HCHG WEST NILE VIRUS IGM SO
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
K3020017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
HCHG WEST NILE VIRUS IGM SO
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
K3020017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$16.85
|
| Rate for Payer: AlohaCare Medicare |
$16.85
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$18.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$16.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.85
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.85
|
| Rate for Payer: University Health Alliance Commercial |
$43.55
|
|
|
HCHG WEST NILE VIRUS SO
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
K3020018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
HCHG WEST NILE VIRUS SO
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
K3020018
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: AlohaCare Medicaid |
$14.39
|
| Rate for Payer: AlohaCare Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$15.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.39
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.39
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HCHG WET MOUNT
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
K3060001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: AlohaCare Medicaid |
$5.82
|
| Rate for Payer: AlohaCare Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$48.10
|
| Rate for Payer: Cash Price |
$48.10
|
| Rate for Payer: Devoted Health Medicare |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.82
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$71.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.82
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG WET MOUNT
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
K3060001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Cash Price |
$48.10
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: MDX Hawaii PPO |
$71.78
|
|
|
HCHG WHITE BLOOD COUNT AUTOMATED
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
H3050264
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
HCHG WHITE BLOOD COUNT AUTOMATED
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 85048
|
| Hospital Charge Code |
H3050264
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: AlohaCare Medicaid |
$2.54
|
| Rate for Payer: AlohaCare Medicare |
$2.54
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Devoted Health Medicare |
$2.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.54
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.54
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.54
|
| Rate for Payer: University Health Alliance Commercial |
$6.57
|
|
|
HCHG WORM ID
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
H3060548
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$4.31
|
| Rate for Payer: AlohaCare Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Devoted Health Medicare |
$4.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.31
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$4.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.31
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.31
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG WORM ID
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
H3060548
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
HCHG WRIGHTS STAIN WBC STOOL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
K3060021
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: AlohaCare Medicaid |
$4.27
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Devoted Health Medicare |
$4.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG WRIGHTS STAIN WBC STOOL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
K3060021
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Cash Price |
$42.25
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
|
|
HCHG WRIST (2 VIEWS)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
H3200896
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| 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 |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$57.07
|
|
|
HCHG WRIST (2 VIEWS)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
H3200896
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HCHG WRIST 2 VIEWS PORT
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
H3200902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| 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 |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$57.07
|
|
|
HCHG WRIST 2 VIEWS PORT
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
H3200902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HCHG WRIST MIN 3 VIEWS
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
H3200900
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| 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 |
$17.34
|
| 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 |
$18.95
|
| 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 |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$66.60
|
|
|
HCHG WRIST MIN 3 VIEWS
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
H3200900
|
|
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 WRIST W NAVICULAR, MIN 3 VIEWS
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
H3200904
|
|
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 WRIST W NAVICULAR, MIN 3 VIEWS
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
H3200904
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| 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 |
$17.34
|
| 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 |
$18.95
|
| 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 |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$66.60
|
|
|
HCHG XOFIGO, PER UCI (NDC 50419-0208-01)
|
Facility
|
OP
|
$846.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
H3440148
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$152.12 |
| Max. Negotiated Rate |
$820.62 |
| Rate for Payer: AlohaCare Medicaid |
$171.09
|
| Rate for Payer: AlohaCare Medicare |
$171.09
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Devoted Health Medicare |
$188.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$213.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$803.70
|
| Rate for Payer: Health Management Network Commercial |
$719.10
|
| Rate for Payer: Humana Medicare |
$171.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$532.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$431.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.09
|
| Rate for Payer: MDX Hawaii PPO |
$820.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$152.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.09
|
| Rate for Payer: University Health Alliance Commercial |
$616.65
|
|
|
HCHG XOFIGO, PER UCI (NDC 50419-0208-01)
|
Facility
|
IP
|
$846.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
H3440148
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$719.10 |
| Max. Negotiated Rate |
$820.62 |
| Rate for Payer: Cash Price |
$549.90
|
| Rate for Payer: Health Management Network Commercial |
$719.10
|
| Rate for Payer: MDX Hawaii PPO |
$820.62
|
|
|
HCHG X-RAY BONE SURVEY COMPLETE
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
H3200962
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG X-RAY BONE SURVEY COMPLETE
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
H3200962
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.32
|
| 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 |
$51.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$446.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$195.99
|
|
|
HCHG X-RAY COMPL ABD SERIES W/S/E/D VIEWS 1 VIEW CHEST
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
H3200964
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| 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 |
$644.30
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$477.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| 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 |
$95.72
|
|
