|
HC EP REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Facility
|
IP
|
$32,935.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
3613322701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27,994.75 |
| Max. Negotiated Rate |
$31,946.95 |
| Rate for Payer: Cash Price |
$19,761.00
|
| Rate for Payer: Health Management Network Commercial |
$27,994.75
|
| Rate for Payer: MDX Hawaii PPO |
$31,946.95
|
|
|
HC EP REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Facility
|
OP
|
$41,648.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
3613322801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$40,398.56 |
| Rate for Payer: AlohaCare Medicaid |
$12,347.41
|
| Rate for Payer: AlohaCare Medicare |
$12,347.41
|
| Rate for Payer: Cash Price |
$24,988.80
|
| Rate for Payer: Cash Price |
$24,988.80
|
| Rate for Payer: Cash Price |
$24,988.80
|
| Rate for Payer: Devoted Health Medicare |
$13,582.15
|
| 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 |
$12,347.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$35,400.80
|
| Rate for Payer: Humana Medicare |
$12,347.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$26,238.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,347.41
|
| Rate for Payer: MDX Hawaii PPO |
$40,398.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13,582.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,347.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,347.41
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC EP REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Facility
|
IP
|
$41,648.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
3613322801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35,400.80 |
| Max. Negotiated Rate |
$40,398.56 |
| Rate for Payer: Cash Price |
$24,988.80
|
| Rate for Payer: Health Management Network Commercial |
$35,400.80
|
| Rate for Payer: MDX Hawaii PPO |
$40,398.56
|
|
|
HC EP REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Facility
|
OP
|
$75,896.00
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
3613322901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$73,619.12 |
| Rate for Payer: AlohaCare Medicaid |
$22,754.70
|
| Rate for Payer: AlohaCare Medicare |
$22,754.70
|
| Rate for Payer: Cash Price |
$45,537.60
|
| Rate for Payer: Cash Price |
$45,537.60
|
| Rate for Payer: Cash Price |
$45,537.60
|
| Rate for Payer: Devoted Health Medicare |
$25,030.17
|
| 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 |
$22,754.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$64,511.60
|
| Rate for Payer: Humana Medicare |
$22,754.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$47,814.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$22,754.70
|
| Rate for Payer: MDX Hawaii PPO |
$73,619.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25,030.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$22,754.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$22,754.70
|
| Rate for Payer: University Health Alliance Commercial |
$11,157.19
|
|
|
HC EP REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Facility
|
IP
|
$75,896.00
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
3613322901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64,511.60 |
| Max. Negotiated Rate |
$73,619.12 |
| Rate for Payer: Cash Price |
$45,537.60
|
| Rate for Payer: Health Management Network Commercial |
$64,511.60
|
| Rate for Payer: MDX Hawaii PPO |
$73,619.12
|
|
|
HC EP REMV PERM PACER GENERATOR
|
Facility
|
IP
|
$32,935.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
3613323301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27,994.75 |
| Max. Negotiated Rate |
$31,946.95 |
| Rate for Payer: Cash Price |
$19,761.00
|
| Rate for Payer: Health Management Network Commercial |
$27,994.75
|
| Rate for Payer: MDX Hawaii PPO |
$31,946.95
|
|
|
HC EP REMV PERM PACER GENERATOR
|
Facility
|
OP
|
$32,935.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
3613323301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$31,946.95 |
| Rate for Payer: AlohaCare Medicaid |
$9,776.09
|
| Rate for Payer: AlohaCare Medicare |
$9,776.09
|
| Rate for Payer: Cash Price |
$19,761.00
|
| Rate for Payer: Cash Price |
$19,761.00
|
| Rate for Payer: Cash Price |
$19,761.00
|
| Rate for Payer: Devoted Health Medicare |
$10,753.70
|
| 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 |
$9,776.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$27,994.75
|
| Rate for Payer: Humana Medicare |
$9,776.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$20,749.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$9,776.09
|
| Rate for Payer: MDX Hawaii PPO |
$31,946.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10,753.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$9,776.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$9,776.09
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC EP REMV TRANSVEN PACER ELECTRODE,2 LEAD
|
Facility
|
IP
|
$14,483.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
4803323501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12,310.55 |
| Max. Negotiated Rate |
$14,048.51 |
| Rate for Payer: Cash Price |
$8,689.80
|
| Rate for Payer: Health Management Network Commercial |
$12,310.55
|
| Rate for Payer: MDX Hawaii PPO |
$14,048.51
|
|
|
HC EP REMV TRANSVEN PACER ELECTRODE,2 LEAD
|
Facility
|
OP
|
$14,483.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
4803323501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$14,048.51 |
| Rate for Payer: AlohaCare Medicaid |
$4,414.64
|
| Rate for Payer: AlohaCare Medicare |
$4,414.64
|
| Rate for Payer: Cash Price |
$8,689.80
|
| Rate for Payer: Cash Price |
$8,689.80
|
| Rate for Payer: Cash Price |
$8,689.80
|
| Rate for Payer: Devoted Health Medicare |
$4,856.10
|
| 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 |
$4,414.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13,758.85
|
| Rate for Payer: Health Management Network Commercial |
$12,310.55
|
| Rate for Payer: Humana Medicare |
$4,414.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$9,124.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7,386.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,414.64
|
| Rate for Payer: MDX Hawaii PPO |
$14,048.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,856.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,414.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,414.64
|
| Rate for Payer: University Health Alliance Commercial |
$10,556.66
|
|
|
HC EP RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Facility
|
IP
|
$89,328.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
3613326201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75,928.80 |
| Max. Negotiated Rate |
$86,648.16 |
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Health Management Network Commercial |
$75,928.80
|
| Rate for Payer: MDX Hawaii PPO |
$86,648.16
|
|
|
HC EP RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Facility
|
OP
|
$89,328.00
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
3613326201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$86,648.16 |
| Rate for Payer: AlohaCare Medicaid |
$26,277.33
|
| Rate for Payer: AlohaCare Medicare |
$26,277.33
|
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Devoted Health Medicare |
$28,905.06
|
| 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 |
$26,277.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$75,928.80
|
| Rate for Payer: Humana Medicare |
$26,277.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$56,276.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$26,277.33
|
| Rate for Payer: MDX Hawaii PPO |
$86,648.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28,905.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$26,277.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$26,277.33
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC EP RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Facility
|
IP
|
$89,328.00
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
3613326301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75,928.80 |
| Max. Negotiated Rate |
$86,648.16 |
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Health Management Network Commercial |
$75,928.80
|
| Rate for Payer: MDX Hawaii PPO |
$86,648.16
|
|
|
HC EP RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Facility
|
OP
|
$89,328.00
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
3613326301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.28 |
| Max. Negotiated Rate |
$86,648.16 |
| Rate for Payer: AlohaCare Medicaid |
$26,277.33
|
| Rate for Payer: AlohaCare Medicare |
$26,277.33
|
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Cash Price |
$53,596.80
|
| Rate for Payer: Devoted Health Medicare |
$28,905.06
|
| 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 |
$26,277.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$75,928.80
|
| Rate for Payer: Humana Medicare |
$26,277.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$56,276.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$26,277.33
|
| Rate for Payer: MDX Hawaii PPO |
$86,648.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28,905.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$26,277.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$26,277.33
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC EP RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Facility
|
OP
|
$127,593.00
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
3613326401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.01 |
| Max. Negotiated Rate |
$123,765.21 |
| Rate for Payer: AlohaCare Medicaid |
$37,081.07
|
| Rate for Payer: AlohaCare Medicare |
$37,081.07
|
| Rate for Payer: Cash Price |
$76,555.80
|
| Rate for Payer: Cash Price |
$76,555.80
|
| Rate for Payer: Cash Price |
$76,555.80
|
| Rate for Payer: Devoted Health Medicare |
$40,789.18
|
| 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 |
$37,081.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,695.11
|
| Rate for Payer: Health Management Network Commercial |
$108,454.05
|
| Rate for Payer: Humana Medicare |
$37,081.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$80,383.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$37,081.07
|
| Rate for Payer: MDX Hawaii PPO |
$123,765.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40,789.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$37,081.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$243.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$37,081.07
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC EP RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Facility
|
IP
|
$127,593.00
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
3613326401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108,454.05 |
| Max. Negotiated Rate |
$123,765.21 |
| Rate for Payer: Cash Price |
$76,555.80
|
| Rate for Payer: Health Management Network Commercial |
$108,454.05
|
| Rate for Payer: MDX Hawaii PPO |
$123,765.21
|
|
|
HC EP RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Facility
|
IP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
3613321501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10,647.10 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
|
|
HC EP RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Facility
|
OP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
3613321501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| 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 |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,427.62
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,891.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
| 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 |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$9,130.20
|
|
|
HC EPSTEIN-BARR ANTIBODY - EPSTEIN-BARR VIRUS EARLY IGG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
3028666301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
HC EPSTEIN-BARR ANTIBODY - EPSTEIN-BARR VIRUS EARLY IGG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
3028666301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: AlohaCare Medicaid |
$13.12
|
| Rate for Payer: AlohaCare Medicare |
$13.12
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Devoted Health Medicare |
$14.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.12
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$13.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.12
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$33.91
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: AlohaCare Medicaid |
$18.14
|
| Rate for Payer: AlohaCare Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Devoted Health Medicare |
$19.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.14
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$18.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.14
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.14
|
| Rate for Payer: University Health Alliance Commercial |
$46.90
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
3028666502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: AlohaCare Medicaid |
$18.14
|
| Rate for Payer: AlohaCare Medicare |
$18.14
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Devoted Health Medicare |
$19.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.14
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$18.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.14
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.14
|
| Rate for Payer: University Health Alliance Commercial |
$46.90
|
|
|
HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
3028666401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: AlohaCare Medicaid |
$15.29
|
| Rate for Payer: AlohaCare Medicare |
$15.29
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Devoted Health Medicare |
$16.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.29
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.29
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.29
|
| Rate for Payer: University Health Alliance Commercial |
$39.55
|
|
|
HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
3028666401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
