|
HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM - COOMBS DIRECT SO
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 86880
|
| Hospital Charge Code |
3008688001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: AlohaCare Medicaid |
$5.39
|
| Rate for Payer: AlohaCare Medicare |
$5.39
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Devoted Health Medicare |
$5.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Humana Medicare |
$5.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.39
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.39
|
| Rate for Payer: University Health Alliance Commercial |
$13.88
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.09
|
| Rate for Payer: AlohaCare Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.09
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.09
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HC ANTINUCLEAR ANTIBODIES - ANA (ANTINUCLEAR ANTIBODIES)
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
3028603801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
3028603902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$11.16
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$12.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.16
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$28.86
|
|
|
HC ANTINUCLEAR ANTIBODIES TITER - ANA TITER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
3028603902
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
3028606001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$7.30
|
| Rate for Payer: AlohaCare Medicare |
$7.30
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$8.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.30
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$7.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.30
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.30
|
| Rate for Payer: University Health Alliance Commercial |
$18.87
|
|
|
HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 86060
|
| Hospital Charge Code |
3028606001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN III
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3058530001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN III
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 85300
|
| Hospital Charge Code |
3058530001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: AlohaCare Medicaid |
$11.85
|
| Rate for Payer: AlohaCare Medicare |
$11.85
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$13.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.85
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$11.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.85
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.85
|
| Rate for Payer: University Health Alliance Commercial |
$30.62
|
|
|
HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
3058530101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 85301
|
| Hospital Charge Code |
3058530101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: AlohaCare Medicaid |
$10.81
|
| Rate for Payer: AlohaCare Medicare |
$10.81
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$11.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.81
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$10.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.81
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.81
|
| Rate for Payer: University Health Alliance Commercial |
$27.95
|
|
|
HC APP FINGER SPLINT DYNM
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4202913101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$69.69
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$69.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.69
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC APP FINGER SPLINT DYNM
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29131
|
| Hospital Charge Code |
4202913101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 20660
|
| Hospital Charge Code |
4502066001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$8,270.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,899.59
|
| Rate for Payer: AlohaCare Medicare |
$1,899.59
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Devoted Health Medicare |
$2,089.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8,270.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,899.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,924.20
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Humana Medicare |
$1,899.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,928.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,899.59
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
| 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 |
$4,545.42
|
|
|
HC APPLICATION OF CRANIAL TONGS, CALIPER, OR STEREOTACTIC FRAME, INCLUDING REMOVAL
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 20660
|
| Hospital Charge Code |
4502066001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,300.60 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.97 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$191.97
|
| Rate for Payer: AlohaCare Medicare |
$191.97
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$211.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$191.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$395.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$191.97
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.97
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
4502908501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND); STATIC
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
4502908601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.97 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$191.97
|
| Rate for Payer: AlohaCare Medicare |
$191.97
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Devoted Health Medicare |
$211.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$569.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$191.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$584.25
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Humana Medicare |
$191.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$191.97
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$191.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$191.97
|
| Rate for Payer: University Health Alliance Commercial |
$448.27
|
|
|
HC APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND); STATIC
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
4502908601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$522.75 |
| Max. Negotiated Rate |
$596.55 |
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
|
|
HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS 96377
|
| Hospital Charge Code |
9409637701
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$231.83 |
| Rate for Payer: AlohaCare Medicaid |
$55.32
|
| Rate for Payer: AlohaCare Medicare |
$55.32
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Devoted Health Medicare |
$60.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$69.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$227.05
|
| Rate for Payer: Health Management Network Commercial |
$203.15
|
| Rate for Payer: Humana Medicare |
$55.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.32
|
| Rate for Payer: MDX Hawaii PPO |
$231.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.32
|
| Rate for Payer: University Health Alliance Commercial |
$174.21
|
|
|
HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS 96377
|
| Hospital Charge Code |
9409637701
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$203.15 |
| Max. Negotiated Rate |
$231.83 |
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Health Management Network Commercial |
$203.15
|
| Rate for Payer: MDX Hawaii PPO |
$231.83
|
|
|
HC APPL SPLNT FINGER STATIC
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130 GO
|
| Hospital Charge Code |
4302913001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$589.05 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
|
|
HC APPL SPLNT FINGER STATIC
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130 GO
|
| Hospital Charge Code |
4302913001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$658.35
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$436.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$353.43
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.15
|
| Rate for Payer: University Health Alliance Commercial |
$505.13
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7002913001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$658.35
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$436.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$353.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$505.13
|
|
|
HC APPLY FINGER SPLINT,STATIC
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
7002913001
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$589.05 |
| Max. Negotiated Rate |
$672.21 |
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Health Management Network Commercial |
$589.05
|
| Rate for Payer: MDX Hawaii PPO |
$672.21
|
|
