|
HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
3108124101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$597.52 |
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Health Management Network Commercial |
$523.60
|
| Rate for Payer: MDX Hawaii PPO |
$597.52
|
|
|
HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
HCPCS 81241
|
| Hospital Charge Code |
3108124101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$597.52 |
| Rate for Payer: AlohaCare Medicaid |
$73.37
|
| Rate for Payer: AlohaCare Medicare |
$73.37
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Devoted Health Medicare |
$80.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$81.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$73.37
|
| Rate for Payer: Health Management Network Commercial |
$523.60
|
| Rate for Payer: Humana Medicare |
$73.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$388.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$314.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.37
|
| Rate for Payer: MDX Hawaii PPO |
$597.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.37
|
| Rate for Payer: University Health Alliance Commercial |
$154.23
|
|
|
HC F ACTIN IGG AB QT/SEMIQT SO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
3018601501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$73.62
|
|
|
HC F ACTIN IGG AB QT/SEMIQT SO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86015
|
| Hospital Charge Code |
3018601501
|
|
Hospital Revenue Code
|
301
|
| 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 FATS/LIPIDS, FECES, QUALITATIVE - FECAL FAT QUALITATIVE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
3018270501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$5.10
|
| Rate for Payer: AlohaCare Medicare |
$5.10
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$5.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.10
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.10
|
| Rate for Payer: University Health Alliance Commercial |
$13.15
|
|
|
HC FATS/LIPIDS, FECES, QUALITATIVE - FECAL FAT QUALITATIVE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
3018270501
|
|
Hospital Revenue Code
|
301
|
| 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 FETAL BIOP PROFILE W/NST - US FETAL BIOPHYS PROF W NON STRESS TEST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$241.61
|
|
|
HC FETAL BIOP PROFILE W/NST - US FETAL BIOPHYS PROF W NON STRESS TEST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76818
|
| Hospital Charge Code |
4027681801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC FETAL BIOP PROFIL W/O NST - US FETAL BIOPHYS PROF WO NON STRESS TEST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
4027681901
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC FETAL BIOP PROFIL W/O NST - US FETAL BIOPHYS PROF WO NON STRESS TEST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76819
|
| Hospital Charge Code |
4027681901
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$195.62
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$850.85 |
| Max. Negotiated Rate |
$970.97 |
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: MDX Hawaii PPO |
$970.97
|
|
|
HC FETAL NON-STRESS TEST
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
7205902501
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$970.97 |
| Rate for Payer: AlohaCare Medicaid |
$238.83
|
| Rate for Payer: AlohaCare Medicare |
$238.83
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Devoted Health Medicare |
$262.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$298.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$238.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$950.95
|
| Rate for Payer: Health Management Network Commercial |
$850.85
|
| Rate for Payer: Humana Medicare |
$238.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$630.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$510.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$238.83
|
| Rate for Payer: MDX Hawaii PPO |
$970.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$238.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$238.83
|
| Rate for Payer: University Health Alliance Commercial |
$729.63
|
|
|
HC FETAL SCREEN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 83030
|
| Hospital Charge Code |
3018303001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HC FETAL SCREEN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 83030
|
| Hospital Charge Code |
3018303001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: AlohaCare Medicaid |
$10.74
|
| Rate for Payer: AlohaCare Medicare |
$10.74
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$11.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$10.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.74
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.74
|
| Rate for Payer: University Health Alliance Commercial |
$21.39
|
|
|
HC FFP 8-24 HRS / 5 DAY
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
383P905901
|
|
Hospital Revenue Code
|
383
|
| Min. Negotiated Rate |
$598.40 |
| Max. Negotiated Rate |
$682.88 |
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Management Network Commercial |
$598.40
|
| Rate for Payer: MDX Hawaii PPO |
$682.88
|
|
|
HC FFP 8-24 HRS / 5 DAY
|
Facility
|
OP
|
$986.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
390P905901
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$956.42 |
| Rate for Payer: AlohaCare Medicaid |
$85.30
|
| Rate for Payer: AlohaCare Medicare |
$85.30
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Devoted Health Medicare |
$93.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$106.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$936.70
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Humana Medicare |
$85.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$621.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$502.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.30
|
| Rate for Payer: MDX Hawaii PPO |
$956.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.30
|
| Rate for Payer: University Health Alliance Commercial |
$718.70
|
|
|
HC FFP 8-24 HRS / 5 DAY
|
Facility
|
IP
|
$986.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
390P905901
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$838.10 |
| Max. Negotiated Rate |
$956.42 |
| Rate for Payer: Cash Price |
$591.60
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: MDX Hawaii PPO |
$956.42
|
|
|
HC FFP 8-24 HRS / 5 DAY
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
383P905901
|
|
Hospital Revenue Code
|
383
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$682.88 |
| Rate for Payer: AlohaCare Medicaid |
$85.30
|
| Rate for Payer: AlohaCare Medicare |
$85.30
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Devoted Health Medicare |
$93.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$106.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$668.80
|
| Rate for Payer: Health Management Network Commercial |
$598.40
|
| Rate for Payer: Humana Medicare |
$85.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$443.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$359.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.30
|
| Rate for Payer: MDX Hawaii PPO |
$682.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.30
|
| Rate for Payer: University Health Alliance Commercial |
$513.15
|
|
|
HC FFR W/O MED ADMIN
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
4819379902
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$117.35 |
| Max. Negotiated Rate |
$755.63 |
| Rate for Payer: AlohaCare Medicaid |
$152.01
|
| Rate for Payer: AlohaCare Medicare |
$152.01
|
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Devoted Health Medicare |
$167.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$190.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$740.05
|
| Rate for Payer: Health Management Network Commercial |
$662.15
|
| Rate for Payer: Humana Medicare |
$152.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$490.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$397.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.01
|
| Rate for Payer: MDX Hawaii PPO |
$755.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.01
|
| Rate for Payer: University Health Alliance Commercial |
$567.81
|
|
|
HC FFR W/O MED ADMIN
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
4819379902
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$662.15 |
| Max. Negotiated Rate |
$755.63 |
| Rate for Payer: Cash Price |
$467.40
|
| Rate for Payer: Health Management Network Commercial |
$662.15
|
| Rate for Payer: MDX Hawaii PPO |
$755.63
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$10.18
|
| Rate for Payer: AlohaCare Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Devoted Health Medicare |
$11.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.18
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Humana Medicare |
$10.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.18
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.18
|
| Rate for Payer: University Health Alliance Commercial |
$26.31
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
|
|
HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
3058538401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: MDX Hawaii PPO |
$79.54
|
|
|
HC FIBRINOGEN, ACTIVITY - FIBRINOGEN,QUANTITATIVE
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
3058538401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: AlohaCare Medicaid |
$9.72
|
| Rate for Payer: AlohaCare Medicare |
$9.72
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Devoted Health Medicare |
$10.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.72
|
| Rate for Payer: Health Management Network Commercial |
$69.70
|
| Rate for Payer: Humana Medicare |
$9.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.72
|
| Rate for Payer: MDX Hawaii PPO |
$79.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.72
|
| Rate for Payer: University Health Alliance Commercial |
$21.96
|
|
|
HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
3611000701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Devoted Health Medicare |
$920.21
|
| 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 |
$836.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,764.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: MDX Hawaii PPO |
$2,716.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$920.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$836.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$836.55
|
| Rate for Payer: University Health Alliance Commercial |
$2,040.92
|
|
