|
HC HEMATOCRIT - HEMATOCRIT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HC HEMATOCRIT - HEMATOCRIT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$2.37
|
| Rate for Payer: AlohaCare Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$2.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.37
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.37
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION
|
Facility
|
OP
|
$2,785.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
8019093501
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$62.86 |
| Max. Negotiated Rate |
$2,701.45 |
| Rate for Payer: AlohaCare Medicaid |
$810.77
|
| Rate for Payer: AlohaCare Medicare |
$810.77
|
| Rate for Payer: Cash Price |
$1,671.00
|
| Rate for Payer: Cash Price |
$1,671.00
|
| Rate for Payer: Devoted Health Medicare |
$891.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,013.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$810.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,645.75
|
| Rate for Payer: Health Management Network Commercial |
$2,367.25
|
| Rate for Payer: Humana Medicare |
$810.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,754.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,420.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$810.77
|
| Rate for Payer: MDX Hawaii PPO |
$2,701.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$891.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$810.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$810.77
|
| Rate for Payer: University Health Alliance Commercial |
$2,029.99
|
|
|
HC HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION
|
Facility
|
IP
|
$2,785.00
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
8019093501
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$2,367.25 |
| Max. Negotiated Rate |
$2,701.45 |
| Rate for Payer: Cash Price |
$1,671.00
|
| Rate for Payer: Health Management Network Commercial |
$2,367.25
|
| Rate for Payer: MDX Hawaii PPO |
$2,701.45
|
|
|
HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBIN FRAC & QN SO
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
3018302101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: AlohaCare Medicaid |
$18.06
|
| Rate for Payer: AlohaCare Medicare |
$18.06
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Devoted Health Medicare |
$19.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.06
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$18.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.06
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.06
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
HC HEMOGLOBIN CHROMOTOGRAPHY - HEMOGLOBIN FRAC & QN SO
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
3018302101
|
|
Hospital Revenue Code
|
301
|
| 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 HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
3018302001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$12.87
|
| Rate for Payer: AlohaCare Medicare |
$12.87
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$14.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.87
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.87
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.87
|
| Rate for Payer: University Health Alliance Commercial |
$33.28
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS - HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
3018302001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC HEMOGLOBIN FETAL,DIFF LYSIS - KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
3058546001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
|
|
HC HEMOGLOBIN FETAL,DIFF LYSIS - KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
3058546001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: AlohaCare Medicaid |
$7.73
|
| Rate for Payer: AlohaCare Medicare |
$7.73
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$8.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.73
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Humana Medicare |
$7.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.73
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.73
|
| Rate for Payer: University Health Alliance Commercial |
$20.00
|
|
|
HC HEMOGLOBIN - HEMOGLOBIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$2.37
|
| Rate for Payer: AlohaCare Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$2.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.37
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.37
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HC HEMOGLOBIN - HEMOGLOBIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HC HEPARIN NEUTRALIZATN - HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 85525
|
| Hospital Charge Code |
3058552501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: AlohaCare Medicaid |
$11.84
|
| Rate for Payer: AlohaCare Medicare |
$11.84
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$13.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.84
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$11.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.84
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.84
|
| Rate for Payer: University Health Alliance Commercial |
$30.16
|
|
|
HC HEPARIN NEUTRALIZATN - HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 85525
|
| Hospital Charge Code |
3058552501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$8.17
|
| Rate for Payer: AlohaCare Medicare |
$8.17
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$8.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$8.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.17
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.17
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: AlohaCare Medicaid |
$12.39
|
| Rate for Payer: AlohaCare Medicare |
$12.39
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$13.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.39
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.39
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.39
|
| Rate for Payer: University Health Alliance Commercial |
$32.02
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$11.26
|
| Rate for Payer: AlohaCare Medicare |
$11.26
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.26
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$11.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.26
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.26
|
| Rate for Payer: University Health Alliance Commercial |
$29.10
|
|
|
HC HEPATITIS B , DNA, QUANT - HEP B VIRUS QUANT SO (HBVDNA)
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3068751701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$348.23 |
| Rate for Payer: AlohaCare Medicaid |
$42.84
|
| Rate for Payer: AlohaCare Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Devoted Health Medicare |
$47.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$53.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.84
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$226.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$183.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.84
|
| Rate for Payer: MDX Hawaii PPO |
$348.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.84
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HC HEPATITIS B , DNA, QUANT - HEP B VIRUS QUANT SO (HBVDNA)
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
3068751701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$305.15 |
| Max. Negotiated Rate |
$348.23 |
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: MDX Hawaii PPO |
$348.23
|
|
|
HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
3028670701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
3028670701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$11.57
|
| Rate for Payer: AlohaCare Medicare |
$11.57
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$12.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$11.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.57
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.57
|
| Rate for Payer: University Health Alliance Commercial |
$29.90
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
