|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| 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 |
$14.84
|
| 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 |
$15.58
|
| 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 |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.74
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: AlohaCare Medicaid |
$14.27
|
| Rate for Payer: AlohaCare Medicare |
$14.27
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Devoted Health Medicare |
$15.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$14.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.27
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.27
|
| Rate for Payer: University Health Alliance Commercial |
$36.89
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HC HEPATITIS C VIRUS SO
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$256.16 |
| Max. Negotiated Rate |
$2,095.20 |
| Rate for Payer: AlohaCare Medicaid |
$257.45
|
| Rate for Payer: AlohaCare Medicare |
$257.45
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Devoted Health Medicare |
$283.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$321.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$355.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$257.45
|
| Rate for Payer: Health Management Network Commercial |
$1,836.00
|
| Rate for Payer: Humana Medicare |
$257.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,360.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,101.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.45
|
| Rate for Payer: MDX Hawaii PPO |
$2,095.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.45
|
| Rate for Payer: University Health Alliance Commercial |
$665.43
|
|
|
HC HEPATITIS C VIRUS SO
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
3068790201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,095.20 |
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Health Management Network Commercial |
$1,836.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,095.20
|
|
|
HC HEPATITIS DELTA VIRUS AB
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
3028669201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
HC HEPATITIS DELTA VIRUS AB
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 86692
|
| Hospital Charge Code |
3028669201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: AlohaCare Medicaid |
$17.16
|
| Rate for Payer: AlohaCare Medicare |
$17.16
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Devoted Health Medicare |
$18.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.16
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$17.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.16
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.16
|
| Rate for Payer: University Health Alliance Commercial |
$44.36
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: AlohaCare Medicaid |
$47.63
|
| Rate for Payer: AlohaCare Medicare |
$47.63
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Devoted Health Medicare |
$52.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.63
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Humana Medicare |
$47.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.63
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.63
|
| Rate for Payer: University Health Alliance Commercial |
$123.10
|
|
|
HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$202.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$276.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$501.63
|
|
|
HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER - NM LIVER FUNCTION
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78226
|
| Hospital Charge Code |
3417822601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
3417822701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$202.87 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$202.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$384.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$202.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$705.77
|
|
|
HC HEPATOBIL SYST IMAGE W/DRUG
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78227
|
| Hospital Charge Code |
3417822701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| 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 HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: AlohaCare Medicaid |
$11.77
|
| Rate for Payer: AlohaCare Medicare |
$11.77
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$12.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.77
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.77
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.77
|
| Rate for Payer: University Health Alliance Commercial |
$30.41
|
|
|
HC HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
3028670401
|
|
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 HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
3028670401
|
|
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 HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
3028669501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HC HERPES SIMPLEX TEST, TYPE 1 - HSV 1 IGG ANTIBODY
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
3028669501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$13.19
|
| Rate for Payer: AlohaCare Medicare |
$13.19
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$14.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.19
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.19
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.19
|
| Rate for Payer: University Health Alliance Commercial |
$34.10
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3028669601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: AlohaCare Medicaid |
$19.35
|
| Rate for Payer: AlohaCare Medicare |
$19.35
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Devoted Health Medicare |
$21.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.35
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.35
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.35
|
| Rate for Payer: University Health Alliance Commercial |
$50.04
|
|
|
HC HERPES SIMPLEX TEST, TYPE 2 - HSV 2 IGG ANTIBODY
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
3028669601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
|
|
HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HERPES SIMPLEX AB IGM SO
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
3028669401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: AlohaCare Medicaid |
$14.39
|
| Rate for Payer: AlohaCare Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$15.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.39
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.39
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HERPES SIMPLEX AB IGM SO
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
3028669401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
3028630801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$5.18
|
| Rate for Payer: AlohaCare Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$5.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.18
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.18
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
3028630801
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
