|
HC FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
3611000701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,380.00 |
| Max. Negotiated Rate |
$2,716.00 |
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Health Management Network Commercial |
$2,380.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,716.00
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
7611002101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,001.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$810.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC FINE NEEDLE ASP;W/O IMAGING GUIDANCE
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
7611002101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
|
|
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: AlohaCare Medicaid |
$61.56
|
| Rate for Payer: AlohaCare Medicare |
$61.56
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Devoted Health Medicare |
$67.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$76.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$326.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.56
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.56
|
| Rate for Payer: University Health Alliance Commercial |
$210.97
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 88184 TC
|
| Hospital Charge Code |
3118818404
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$3,029.40 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
|
|
HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 88184 TC
|
| Hospital Charge Code |
3118818404
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,385.80
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,245.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,817.64
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.71
|
| Rate for Payer: University Health Alliance Commercial |
$152.44
|
|
|
HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
HCPCS 88185 TC
|
| Hospital Charge Code |
3118818501
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$306.52 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$300.20
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$199.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.16
|
| Rate for Payer: MDX Hawaii PPO |
$306.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.96
|
| Rate for Payer: University Health Alliance Commercial |
$86.75
|
|
|
HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
HCPCS 88185 TC
|
| Hospital Charge Code |
3118818501
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$268.60 |
| Max. Negotiated Rate |
$306.52 |
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Health Management Network Commercial |
$268.60
|
| Rate for Payer: MDX Hawaii PPO |
$306.52
|
|
|
HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
|
Facility
|
IP
|
$1,389.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
3108124501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,180.65 |
| Max. Negotiated Rate |
$1,347.33 |
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,347.33
|
|
|
HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
|
Facility
|
OP
|
$1,389.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
3108124501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$1,347.33 |
| Rate for Payer: AlohaCare Medicaid |
$165.51
|
| Rate for Payer: AlohaCare Medicare |
$165.51
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Devoted Health Medicare |
$182.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.51
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: Humana Medicare |
$165.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$875.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$708.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.51
|
| Rate for Payer: MDX Hawaii PPO |
$1,347.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.51
|
| Rate for Payer: University Health Alliance Commercial |
$207.20
|
|
|
HC FLUORESCENT ANTIBODY; SCREEN - FLUOR AB SCRN EA AB SO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3028625501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| 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 |
$17.49
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HC FLUORESCENT ANTIBODY; SCREEN - FLUOR AB SCRN EA AB SO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3028625501
|
|
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 FLUORESCENT ANTIBODY; SCREEN - NMDA RECPT AB IGG
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3028625503
|
|
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 FLUORESCENT ANTIBODY; SCREEN - NMDA RECPT AB IGG
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3028625503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| 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 |
$17.49
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HC FLUORESCENT ANTIBODY; SCREEN - STRIATED MUSCLE AB EA SO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3028625502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| 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 |
$17.49
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HC FLUORESCENT ANTIBODY; SCREEN - STRIATED MUSCLE AB EA SO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
3028625502
|
|
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 FLUORESCENT ANTIBODY; TITER - FLUORESC AB TITER EA SO
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625601
|
|
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 FLUORESCENT ANTIBODY; TITER - FLUORESC AB TITER EA SO
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
3028625601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| 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 |
$17.49
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HC FLUOROGUIDE FOR VEIN DEVICE - FL GUIDED VENOUS ACCESS
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
3207700101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HC FLUOROGUIDE FOR VEIN DEVICE - FL GUIDED VENOUS ACCESS
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
3207700101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$452.20
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.23
|
| Rate for Payer: University Health Alliance Commercial |
$195.54
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL LESS THAN 1 HOUR INTRAOPERATIVE
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600004
|
|
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 FLUOROSCOPY <1 HR PHYS/QHP - FL LESS THAN 1 HOUR INTRAOPERATIVE
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$1,166.91 |
| 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: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| 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 |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$179.71
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL SNIFF TEST
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$1,166.91 |
| 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: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| 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 |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$179.71
|
|
|
HC FLUOROSCOPY <1 HR PHYS/QHP - FL SNIFF TEST
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
3207600003
|
|
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
|
|
