|
HC ELECTRON MICROSCOPY SO
|
Facility
|
IP
|
$8,094.00
|
|
|
Service Code
|
HCPCS 88348
|
| Hospital Charge Code |
3108834801
|
|
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 EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
4509928101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$647.70 |
| Max. Negotiated Rate |
$739.14 |
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Health Management Network Commercial |
$647.70
|
| Rate for Payer: MDX Hawaii PPO |
$739.14
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
4509928101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.62 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$99.62
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Devoted Health Medicare |
$109.58
|
| 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 |
$99.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$723.90
|
| Rate for Payer: Health Management Network Commercial |
$647.70
|
| Rate for Payer: Humana Medicare |
$99.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$480.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.62
|
| Rate for Payer: MDX Hawaii PPO |
$739.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.62
|
| Rate for Payer: University Health Alliance Commercial |
$555.42
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$181.39
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Devoted Health Medicare |
$199.53
|
| 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 |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,254.95
|
| Rate for Payer: Health Management Network Commercial |
$1,122.85
|
| Rate for Payer: Humana Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$832.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: MDX Hawaii PPO |
$1,281.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: University Health Alliance Commercial |
$962.88
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,122.85 |
| Max. Negotiated Rate |
$1,281.37 |
| Rate for Payer: Cash Price |
$792.60
|
| Rate for Payer: Health Management Network Commercial |
$1,122.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,281.37
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Facility
|
IP
|
$1,807.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,535.95 |
| Max. Negotiated Rate |
$1,752.79 |
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Health Management Network Commercial |
$1,535.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,752.79
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Facility
|
OP
|
$1,807.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,752.79 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$322.48
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Cash Price |
$1,084.20
|
| Rate for Payer: Devoted Health Medicare |
$354.73
|
| 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 |
$322.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,716.65
|
| Rate for Payer: Health Management Network Commercial |
$1,535.95
|
| Rate for Payer: Humana Medicare |
$322.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,138.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$322.48
|
| Rate for Payer: MDX Hawaii PPO |
$1,752.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$322.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$322.48
|
| Rate for Payer: University Health Alliance Commercial |
$1,317.12
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Facility
|
IP
|
$3,071.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,610.35 |
| Max. Negotiated Rate |
$2,978.87 |
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Health Management Network Commercial |
$2,610.35
|
| Rate for Payer: MDX Hawaii PPO |
$2,978.87
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Facility
|
OP
|
$3,071.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$2,978.87 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$492.93
|
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Cash Price |
$1,842.60
|
| Rate for Payer: Devoted Health Medicare |
$542.22
|
| 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 |
$492.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,917.45
|
| Rate for Payer: Health Management Network Commercial |
$2,610.35
|
| Rate for Payer: Humana Medicare |
$492.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,934.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.93
|
| Rate for Payer: MDX Hawaii PPO |
$2,978.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$542.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.93
|
| Rate for Payer: University Health Alliance Commercial |
$2,238.45
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
IP
|
$3,561.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
6839928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,026.85 |
| Max. Negotiated Rate |
$3,454.17 |
| Rate for Payer: Cash Price |
$2,136.60
|
| Rate for Payer: Health Management Network Commercial |
$3,026.85
|
| Rate for Payer: MDX Hawaii PPO |
$3,454.17
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
OP
|
$3,561.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
6839928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$3,454.17 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$703.53
|
| Rate for Payer: Cash Price |
$2,136.60
|
| Rate for Payer: Cash Price |
$2,136.60
|
| Rate for Payer: Cash Price |
$2,136.60
|
| Rate for Payer: Cash Price |
$2,136.60
|
| Rate for Payer: Devoted Health Medicare |
$773.88
|
| 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 |
$703.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,382.95
|
| Rate for Payer: Health Management Network Commercial |
$3,026.85
|
| Rate for Payer: Humana Medicare |
$703.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,243.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$703.53
|
| Rate for Payer: MDX Hawaii PPO |
$3,454.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$773.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$703.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$703.53
|
| Rate for Payer: University Health Alliance Commercial |
$2,595.61
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
IP
|
$4,879.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,147.15 |
| Max. Negotiated Rate |
$4,732.63 |
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Health Management Network Commercial |
$4,147.15
|
| Rate for Payer: MDX Hawaii PPO |
$4,732.63
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
OP
|
$4,879.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$4,732.63 |
| Rate for Payer: AlohaCare Medicaid |
$140.00
|
| Rate for Payer: AlohaCare Medicare |
$703.53
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Cash Price |
$2,927.40
|
| Rate for Payer: Devoted Health Medicare |
$773.88
|
| 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 |
$703.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,635.05
|
| Rate for Payer: Health Management Network Commercial |
$4,147.15
|
| Rate for Payer: Humana Medicare |
$703.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,073.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$703.53
|
| Rate for Payer: MDX Hawaii PPO |
$4,732.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$773.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$703.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$703.53
|
| Rate for Payer: University Health Alliance Commercial |
$3,556.30
|
|
|
HC ENDOMYSIAL AB TITER SO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
3028623101
|
|
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 ENDOMYSIAL AB TITER SO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86231
|
| Hospital Charge Code |
3028623101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.25 |
| 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 |
$7.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.09
|
| Rate for Payer: University Health Alliance Commercial |
$73.62
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
3613647601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.35 |
| Max. Negotiated Rate |
$185.27 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Health Management Network Commercial |
$162.35
|
| Rate for Payer: MDX Hawaii PPO |
$185.27
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 36476
|
| Hospital Charge Code |
3613647601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Health Management Network Commercial |
$162.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: MDX Hawaii PPO |
$185.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.03
|
| Rate for Payer: University Health Alliance Commercial |
$139.22
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS PCR CSF
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
3068749802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS PCR CSF
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
3068749802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS PCR PLASMA SO
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
3068749801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS PCR PLASMA SO
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
3068749801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC ENZYME HISTOCHEMISTRY - HISTOCHEM TO ID ENZYME EA
|
Facility
|
OP
|
$8,094.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
3108831901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.20 |
| 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 |
$81.20
|
| 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 |
$103.70
|
| 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 |
$81.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$951.79
|
| Rate for Payer: University Health Alliance Commercial |
$301.18
|
|
|
HC ENZYME HISTOCHEMISTRY - HISTOCHEM TO ID ENZYME EA
|
Facility
|
IP
|
$8,094.00
|
|
|
Service Code
|
HCPCS 88319
|
| Hospital Charge Code |
3108831901
|
|
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 EOSINOPHILS URINE
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC EOSINOPHILS URINE
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$4.27
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$4.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
