|
HC CONTRAST EXAM ABDOMINL AORTA - IR AORTAGRAM ABDOMNL SERIALOGRAM
|
Facility
|
OP
|
$15,658.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
3237562501
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$414.83 |
| Max. Negotiated Rate |
$15,188.26 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Cash Price |
$9,394.80
|
| Rate for Payer: Cash Price |
$9,394.80
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$414.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,662.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$435.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,730.07
|
| Rate for Payer: Health Management Network Commercial |
$13,309.30
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,864.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7,985.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: MDX Hawaii PPO |
$15,188.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,103.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,730.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$414.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$761.39
|
|
|
HC CONTRAST EXAM ABDOMINL AORTA - IR AORTAGRAM ABDOMNL SERIALOGRAM
|
Facility
|
IP
|
$15,658.00
|
|
|
Service Code
|
HCPCS 75625
|
| Hospital Charge Code |
3237562501
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$13,309.30 |
| Max. Negotiated Rate |
$15,188.26 |
| Rate for Payer: Cash Price |
$9,394.80
|
| Rate for Payer: Health Management Network Commercial |
$13,309.30
|
| Rate for Payer: MDX Hawaii PPO |
$15,188.26
|
|
|
HC CONTRAST EXAM THORACIC AORTA - IR AORTAGRAM THORACIC SERIALOGRAM
|
Facility
|
IP
|
$26,891.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
3237560501
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$22,857.35 |
| Max. Negotiated Rate |
$26,084.27 |
| Rate for Payer: Cash Price |
$16,134.60
|
| Rate for Payer: Health Management Network Commercial |
$22,857.35
|
| Rate for Payer: MDX Hawaii PPO |
$26,084.27
|
|
|
HC CONTRAST EXAM THORACIC AORTA - IR AORTAGRAM THORACIC SERIALOGRAM
|
Facility
|
OP
|
$26,891.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
3237560501
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$414.83 |
| Max. Negotiated Rate |
$26,084.27 |
| Rate for Payer: AlohaCare Medicaid |
$6,573.58
|
| Rate for Payer: AlohaCare Medicare |
$6,573.58
|
| Rate for Payer: Cash Price |
$16,134.60
|
| Rate for Payer: Cash Price |
$16,134.60
|
| Rate for Payer: Cash Price |
$16,134.60
|
| Rate for Payer: Devoted Health Medicare |
$7,230.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,395.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6,573.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,695.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,573.58
|
| Rate for Payer: Health Management Network Commercial |
$22,857.35
|
| Rate for Payer: Humana Medicare |
$6,573.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16,941.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13,714.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,573.58
|
| Rate for Payer: MDX Hawaii PPO |
$26,084.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,230.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,573.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$414.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,573.58
|
| Rate for Payer: University Health Alliance Commercial |
$769.69
|
|
|
HC CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
3614942401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$850.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: MDX Hawaii PPO |
$970.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.35
|
| Rate for Payer: University Health Alliance Commercial |
$728.90
|
|
|
HC CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 49424
|
| Hospital Charge Code |
3614942401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Health Management Network Commercial |
$850.00
|
| Rate for Payer: MDX Hawaii PPO |
$970.00
|
|
|
HC CONTRAST INJ CENT VEN CATH, INC FLOURO
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
3613659801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$712.30 |
| Max. Negotiated Rate |
$812.86 |
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
|
|
HC CONTRAST INJ CENT VEN CATH, INC FLOURO
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
3613659801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$251.28
|
| Rate for Payer: AlohaCare Medicare |
$251.28
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Cash Price |
$502.80
|
| Rate for Payer: Devoted Health Medicare |
$276.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$251.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$712.30
|
| Rate for Payer: Humana Medicare |
$251.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$527.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.28
|
| Rate for Payer: MDX Hawaii PPO |
$812.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$276.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$251.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$251.28
|
| Rate for Payer: University Health Alliance Commercial |
$610.82
|
|
|
HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
3204946501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,022.55 |
| Max. Negotiated Rate |
$1,166.91 |
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Health Management Network Commercial |
$1,022.55
|
| Rate for Payer: MDX Hawaii PPO |
$1,166.91
|
|
|
HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
3204946501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,142.85
|
| Rate for Payer: Health Management Network Commercial |
$1,022.55
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$757.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$613.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$1,166.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$876.87
|
|
|
HC CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|
|
HC CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$5,509.00 |
| Rate for Payer: AlohaCare Medicaid |
$279.80
|
| Rate for Payer: AlohaCare Medicare |
$279.80
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$307.78
|
| 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 |
$279.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$279.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$582.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.80
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.80
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI WITH DOUBLE CONT W/O KUB
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
3207424601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$752.25 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI WITH DOUBLE CONT W/O KUB
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
3207424601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$858.45 |
| Rate for Payer: AlohaCare Medicaid |
$207.21
|
| Rate for Payer: AlohaCare Medicare |
$207.21
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Devoted Health Medicare |
$227.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$259.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$207.21
|
| Rate for Payer: Health Management Network Commercial |
$752.25
|
| Rate for Payer: Humana Medicare |
$207.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$557.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$451.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.21
|
| Rate for Payer: MDX Hawaii PPO |
$858.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.21
|
| Rate for Payer: University Health Alliance Commercial |
$237.13
|
|
|
HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Facility
|
IP
|
$7,549.00
|
|
|
Service Code
|
HCPCS 49446
|
| Hospital Charge Code |
3614944601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,416.65 |
| Max. Negotiated Rate |
$7,322.53 |
| Rate for Payer: Cash Price |
$4,529.40
|
| Rate for Payer: Health Management Network Commercial |
$6,416.65
|
| Rate for Payer: MDX Hawaii PPO |
$7,322.53
|
|
|
HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Facility
|
OP
|
$7,549.00
|
|
|
Service Code
|
HCPCS 49446
|
| Hospital Charge Code |
3614944601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$7,322.53 |
| Rate for Payer: AlohaCare Medicaid |
$2,266.89
|
| Rate for Payer: AlohaCare Medicare |
$2,266.89
|
| Rate for Payer: Cash Price |
$4,529.40
|
| Rate for Payer: Cash Price |
$4,529.40
|
| Rate for Payer: Cash Price |
$4,529.40
|
| Rate for Payer: Devoted Health Medicare |
$2,493.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,266.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$6,416.65
|
| Rate for Payer: Humana Medicare |
$2,266.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,755.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,266.89
|
| Rate for Payer: MDX Hawaii PPO |
$7,322.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,493.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,266.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,266.89
|
| Rate for Payer: University Health Alliance Commercial |
$5,502.47
|
|
|
HC CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
3615043401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: AlohaCare Medicaid |
$2,469.46
|
| Rate for Payer: AlohaCare Medicare |
$2,469.46
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Devoted Health Medicare |
$2,716.41
|
| 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 |
$2,469.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: Humana Medicare |
$2,469.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,135.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,469.46
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,716.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,469.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,469.46
|
| Rate for Payer: University Health Alliance Commercial |
$5,941.99
|
|
|
HC CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
3615043401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,929.20 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
|
|
HC CORTISOL, FREE - CORTISOL, FREE
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
HC CORTISOL, FREE - CORTISOL, FREE
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
3018253002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$16.71
|
| Rate for Payer: AlohaCare Medicare |
$16.71
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Devoted Health Medicare |
$18.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.71
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$16.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.71
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.71
|
| Rate for Payer: University Health Alliance Commercial |
$43.20
|
|
|
HC CPK ISOENZYMES SO
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
3018255201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: AlohaCare Medicaid |
$13.39
|
| Rate for Payer: AlohaCare Medicare |
$13.39
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Devoted Health Medicare |
$14.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.39
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$13.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.39
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.39
|
| Rate for Payer: University Health Alliance Commercial |
$34.61
|
|
|
HC CPK ISOENZYMES SO
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
3018255201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$5.18
|
| Rate for Payer: AlohaCare Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$5.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.18
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.18
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC C-REACTIVE PROTEIN HIGH SENSITIVITY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86141
|
| Hospital Charge Code |
3028614101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$12.95
|
| Rate for Payer: AlohaCare Medicare |
$12.95
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$14.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.95
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$12.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.95
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.95
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
