|
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
|
|
|
HCHG X-RAY EXAM CHILD NOSE TO RECTUM FB 1 VIEW
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
H3200971
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$323.85 |
| Max. Negotiated Rate |
$369.57 |
| Rate for Payer: Cash Price |
$247.65
|
| Rate for Payer: Health Management Network Commercial |
$323.85
|
| Rate for Payer: MDX Hawaii PPO |
$369.57
|
|
|
HCHG X-RAY EXAM CHILD NOSE TO RECTUM FB 1 VIEW
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
HCPCS 76010
|
| Hospital Charge Code |
H3200971
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$369.57 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$247.65
|
| Rate for Payer: Cash Price |
$247.65
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| 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 |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$323.85
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$240.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$194.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$369.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$57.68
|
|
|
HCHG X-RAY EXAM INFANT LOWER EXTREMITY MIN 2 VIEWS
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
H3200970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$401.58 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| 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 |
$351.90
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$401.58
|
| 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 |
$56.28
|
|
|
HCHG X-RAY EXAM INFANT LOWER EXTREMITY MIN 2 VIEWS
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 73592
|
| Hospital Charge Code |
H3200970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$401.58 |
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: MDX Hawaii PPO |
$401.58
|
|
|
HCHG X-RAY EXAM INFANT UPPER EXTREMITY MIN 2 VIEWS
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
H3200972
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.90 |
| Max. Negotiated Rate |
$459.78 |
| Rate for Payer: Cash Price |
$308.10
|
| Rate for Payer: Health Management Network Commercial |
$402.90
|
| Rate for Payer: MDX Hawaii PPO |
$459.78
|
|
|
HCHG X-RAY EXAM INFANT UPPER EXTREMITY MIN 2 VIEWS
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
H3200972
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$459.78 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$308.10
|
| Rate for Payer: Cash Price |
$308.10
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.41
|
| 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 |
$17.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$402.90
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$241.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$459.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$56.28
|
|
|
HCHG X-RAY EXAM OF FACIAL BONES
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
H3201014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$441.35 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$295.75
|
| Rate for Payer: Cash Price |
$295.75
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.40
|
| 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 |
$22.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$386.75
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$286.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$441.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$64.21
|
|
|
HCHG X-RAY EXAM OF FACIAL BONES
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 70140
|
| Hospital Charge Code |
H3201014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$441.35 |
| Rate for Payer: Cash Price |
$295.75
|
| Rate for Payer: Health Management Network Commercial |
$386.75
|
| Rate for Payer: MDX Hawaii PPO |
$441.35
|
|
|
HCHG X-RAY EXAM OF FEMUR 2/>
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
H3200368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.87
|
| 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 |
$21.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$403.75
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$460.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$67.43
|
|
|
HCHG X-RAY EXAM OF FEMUR 2/>
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
H3200368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$403.75 |
| Max. Negotiated Rate |
$460.75 |
| Rate for Payer: Cash Price |
$308.75
|
| Rate for Payer: Health Management Network Commercial |
$403.75
|
| Rate for Payer: MDX Hawaii PPO |
$460.75
|
|
|
HCHG X-RAY EXAM SI JOINTS
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 72200
|
| Hospital Charge Code |
H3201015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.25 |
| Max. Negotiated Rate |
$334.65 |
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Health Management Network Commercial |
$293.25
|
| Rate for Payer: MDX Hawaii PPO |
$334.65
|
|
|
HCHG X-RAY EXAM SI JOINTS
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 72200
|
| Hospital Charge Code |
H3201015
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$334.65 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| 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 |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$293.25
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$334.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$59.38
|
|
|
HCHG X-RAY EXAM THORAC SPINE4/>VW
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
H3201011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$461.55 |
| Max. Negotiated Rate |
$526.71 |
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: MDX Hawaii PPO |
$526.71
|
|
|
HCHG X-RAY EXAM THORAC SPINE4/>VW
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 72074
|
| Hospital Charge Code |
H3201011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$526.71 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.26
|
| 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 |
$32.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$342.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$526.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$93.89
|
|
|
HCHG YERSINIA STOOL CULT
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
H3060550
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: AlohaCare Medicaid |
$9.44
|
| Rate for Payer: AlohaCare Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$9.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.44
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.44
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HCHG YERSINIA STOOL CULT
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
H3060550
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
HCHG ZINC PLASMA 90
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
H3011302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$11.39
|
| Rate for Payer: AlohaCare Medicare |
$11.39
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$12.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.39
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$11.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.39
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.39
|
| Rate for Payer: University Health Alliance Commercial |
$29.43
|
|
|
HCHG ZINC PLASMA 90
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
H3011302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
HCHG ZINC SO
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
K3010048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
HCHG ZINC SO
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
K3010048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$11.39
|
| Rate for Payer: AlohaCare Medicare |
$11.39
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$12.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.39
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$11.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.39
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.39
|
| Rate for Payer: University Health Alliance Commercial |
$29.43
|
|
|
Hd Scorpion Needle AR-13999HDN [3644085]
|
Facility
|
OP
|
$1,171.23
|
|
| Hospital Charge Code |
3644085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.33 |
| Max. Negotiated Rate |
$1,136.09 |
| Rate for Payer: Cash Price |
$761.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,112.67
|
| Rate for Payer: Health Management Network Commercial |
$995.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$737.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$597.33
|
| Rate for Payer: MDX Hawaii PPO |
$1,136.09
|
| Rate for Payer: University Health Alliance Commercial |
$853.71
|
|
|
Hd Scorpion Needle AR-13999HDN [3644085]
|
Facility
|
IP
|
$1,171.23
|
|
| Hospital Charge Code |
3644085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$995.55 |
| Max. Negotiated Rate |
$1,136.09 |
| Rate for Payer: Cash Price |
$761.30
|
| Rate for Payer: Health Management Network Commercial |
$995.55
|
| Rate for Payer: MDX Hawaii PPO |
$1,136.09
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$19,335.53
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$14,742.93 |
| Max. Negotiated Rate |
$19,335.53 |
| Rate for Payer: AlohaCare Medicare |
$14,742.93
|
| Rate for Payer: Devoted Health Medicare |
$16,217.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,934.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14,742.93
|
| Rate for Payer: Humana Medicare |
$14,742.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$19,335.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$14,742.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$14,742.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$14,742.93
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$15,934.73
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$10,999.66 |
| Max. Negotiated Rate |
$15,934.73 |
| Rate for Payer: AlohaCare Medicare |
$10,999.66
|
| Rate for Payer: Devoted Health Medicare |
$12,099.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,934.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10,999.66
|
| Rate for Payer: Humana Medicare |
$10,999.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,426.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$10,999.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$10,999.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$10,999.66
|
|
