|
HC COMPATIB AHG
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
3008692201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: AlohaCare Medicaid |
$201.27
|
| Rate for Payer: AlohaCare Medicare |
$201.27
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Devoted Health Medicare |
$221.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.27
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: Humana Medicare |
$201.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,069.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$865.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.27
|
| Rate for Payer: University Health Alliance Commercial |
$1,237.67
|
|
|
HC COMPATIB IMMED SPIN EA
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: AlohaCare Medicaid |
$201.27
|
| Rate for Payer: AlohaCare Medicare |
$201.27
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Devoted Health Medicare |
$221.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.27
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: Humana Medicare |
$201.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,069.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$865.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.27
|
| Rate for Payer: University Health Alliance Commercial |
$42.35
|
|
|
HC COMPATIB IMMED SPIN EA
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
3008692001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,443.30 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
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 COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616003
|
|
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 COMPLEMENT, ANTIGEN - COMPLEMENT CIQ SO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLEMENT, ANTIGEN - COMPLEMENT CIQ SO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616004
|
|
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 COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR PANEL
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
3028616101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.00
|
| Rate for Payer: AlohaCare Medicare |
$12.00
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLEMENT/FUNCTION ACTIVITY - C1 ESTERASE INHIBITOR PANEL
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86161
|
| Hospital Charge Code |
3028616101
|
|
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 COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
3028616201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$20.32
|
| Rate for Payer: AlohaCare Medicare |
$20.32
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Devoted Health Medicare |
$22.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.32
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Humana Medicare |
$20.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.32
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.32
|
| Rate for Payer: University Health Alliance Commercial |
$52.52
|
|
|
HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
3028616201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: AlohaCare Medicaid |
$7.77
|
| Rate for Payer: AlohaCare Medicare |
$7.77
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$8.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.77
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.77
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: AlohaCare Medicaid |
$6.47
|
| Rate for Payer: AlohaCare Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$7.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.47
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.47
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,681.50 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: AlohaCare Medicaid |
$3,431.47
|
| Rate for Payer: AlohaCare Medicare |
$3,431.47
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Devoted Health Medicare |
$3,774.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,431.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,820.50
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Humana Medicare |
$3,431.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,175.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,431.47
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,774.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,431.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,431.47
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC CONCENTRATION INF AGNT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$6.68
|
| Rate for Payer: AlohaCare Medicare |
$6.68
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$7.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.68
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$6.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.68
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.68
|
| Rate for Payer: University Health Alliance Commercial |
$17.26
|
|
|
HC CONCENTRATION INF AGNT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
HC CONSULT CYTOPATH INITIAL
|
Facility
|
OP
|
$8,094.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
3108833301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$7,851.18 |
| Rate for Payer: AlohaCare Medicaid |
$951.79
|
| Rate for Payer: AlohaCare Medicare |
$951.79
|
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: Devoted Health Medicare |
$1,046.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,189.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$951.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$951.79
|
| Rate for Payer: Health Management Network Commercial |
$6,879.90
|
| Rate for Payer: Humana Medicare |
$951.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,099.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,127.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$951.79
|
| Rate for Payer: MDX Hawaii PPO |
$7,851.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,046.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$951.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$951.79
|
| Rate for Payer: University Health Alliance Commercial |
$174.99
|
|
|
HC CONSULT CYTOPATH INITIAL
|
Facility
|
IP
|
$8,094.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
3108833301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6,879.90 |
| Max. Negotiated Rate |
$7,851.18 |
| Rate for Payer: Cash Price |
$4,856.40
|
| Rate for Payer: Health Management Network Commercial |
$6,879.90
|
| Rate for Payer: MDX Hawaii PPO |
$7,851.18
|
|
|
HC CONT RAD PHYSICS CONSULT
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 77336
|
| Hospital Charge Code |
3337733601
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
|
HC CONT RAD PHYSICS CONSULT
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 77336
|
| Hospital Charge Code |
3337733601
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$105.25 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$110.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$173.22
|
|
