|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
4504604001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,988.20 |
| Max. Negotiated Rate |
$4,551.24 |
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
4504604001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,413.65
|
| Rate for Payer: AlohaCare Medicare |
$1,413.65
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Devoted Health Medicare |
$1,555.02
|
| 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 |
$1,413.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,457.40
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Humana Medicare |
$1,413.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,955.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,413.65
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,555.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,413.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,413.65
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG SUBCLASSES SO
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
3018278701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: AlohaCare Medicaid |
$8.02
|
| Rate for Payer: AlohaCare Medicare |
$8.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Devoted Health Medicare |
$8.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$8.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.02
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.02
|
| Rate for Payer: University Health Alliance Commercial |
$20.72
|
|
|
HC IGG1, 2, 3 OR 4, EACH - IGG SUBCLASSES SO
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82787
|
| Hospital Charge Code |
3018278701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
HC IGH GENE REARRANGE AMP METH SO
|
Facility
|
IP
|
$1,661.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
3108126101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,411.85 |
| Max. Negotiated Rate |
$1,611.17 |
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Health Management Network Commercial |
$1,411.85
|
| Rate for Payer: MDX Hawaii PPO |
$1,611.17
|
|
|
HC IGH GENE REARRANGE AMP METH SO
|
Facility
|
OP
|
$1,661.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
3108126101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$1,611.17 |
| Rate for Payer: AlohaCare Medicaid |
$197.99
|
| Rate for Payer: AlohaCare Medicare |
$197.99
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Cash Price |
$996.60
|
| Rate for Payer: Devoted Health Medicare |
$217.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$247.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$265.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.99
|
| Rate for Payer: Health Management Network Commercial |
$1,411.85
|
| Rate for Payer: Humana Medicare |
$197.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,046.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$847.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.99
|
| Rate for Payer: MDX Hawaii PPO |
$1,611.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.99
|
| Rate for Payer: University Health Alliance Commercial |
$1,210.70
|
|
|
HC IGH MUTATION ANALYSIS SO
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
3108126301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,100.35 |
| Max. Negotiated Rate |
$2,396.87 |
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Health Management Network Commercial |
$2,100.35
|
| Rate for Payer: MDX Hawaii PPO |
$2,396.87
|
|
|
HC IGH MUTATION ANALYSIS SO
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
HCPCS 81263
|
| Hospital Charge Code |
3108126301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$2,396.87 |
| Rate for Payer: AlohaCare Medicaid |
$294.52
|
| Rate for Payer: AlohaCare Medicare |
$294.52
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Cash Price |
$1,482.60
|
| Rate for Payer: Devoted Health Medicare |
$323.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$368.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$294.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$394.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$294.52
|
| Rate for Payer: Health Management Network Commercial |
$2,100.35
|
| Rate for Payer: Humana Medicare |
$294.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,556.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,260.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.52
|
| Rate for Payer: MDX Hawaii PPO |
$2,396.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$323.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$294.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$294.52
|
| Rate for Payer: University Health Alliance Commercial |
$1,801.11
|
|
|
HC IKG GENE REARRANGEMENT SO
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
3108126401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,231.65 |
| Max. Negotiated Rate |
$1,405.53 |
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Health Management Network Commercial |
$1,231.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,405.53
|
|
|
HC IKG GENE REARRANGEMENT SO
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 81264
|
| Hospital Charge Code |
3108126401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.19 |
| Max. Negotiated Rate |
$1,405.53 |
| Rate for Payer: AlohaCare Medicaid |
$172.73
|
| Rate for Payer: AlohaCare Medicare |
$172.73
|
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Cash Price |
$869.40
|
| Rate for Payer: Devoted Health Medicare |
$190.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$215.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$199.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$172.73
|
| Rate for Payer: Health Management Network Commercial |
$1,231.65
|
| Rate for Payer: Humana Medicare |
$172.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$912.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$738.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.73
|
| Rate for Payer: MDX Hawaii PPO |
$1,405.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.73
|
| Rate for Payer: University Health Alliance Commercial |
$1,056.18
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
|
OP
|
$8,060.00
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
3614940701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,818.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,438.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,951.11
|
| Rate for Payer: Health Management Network Commercial |
$6,851.00
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,077.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$7,818.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,874.93
|
|
|
HC IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL
|
Facility
|
IP
|
$8,060.00
|
|
|
Service Code
|
HCPCS 49407
|
| Hospital Charge Code |
3614940701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,851.00 |
| Max. Negotiated Rate |
$7,818.20 |
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Health Management Network Commercial |
$6,851.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,818.20
|
|
|
HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
3611003001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$836.55
|
| Rate for Payer: AlohaCare Medicare |
$836.55
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| 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 |
$2,975.00
|
| Rate for Payer: Humana Medicare |
$836.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,205.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$836.55
|
| Rate for Payer: MDX Hawaii PPO |
$3,395.00
|
| 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 |
$4,035.20
|
|
|
HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
3611003001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,975.00 |
| Max. Negotiated Rate |
$3,395.00 |
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Health Management Network Commercial |
$2,975.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,395.00
|
|
|
HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ
|
Facility
|
OP
|
$8,060.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
3294940501
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$7,818.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,657.00
|
| Rate for Payer: Health Management Network Commercial |
$6,851.00
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,077.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,110.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$7,818.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,874.93
|
|
|
HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ
|
Facility
|
IP
|
$8,060.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
3294940501
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$6,851.00 |
| Max. Negotiated Rate |
$7,818.20 |
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Health Management Network Commercial |
$6,851.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,818.20
|
|
|
HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Facility
|
OP
|
$8,060.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
3504940601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$7,818.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,657.00
|
| Rate for Payer: Health Management Network Commercial |
$6,851.00
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,077.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,110.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$7,818.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,146.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,951.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$5,874.93
|
|
|
HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Facility
|
IP
|
$8,060.00
|
|
|
Service Code
|
HCPCS 49406
|
| Hospital Charge Code |
3504940601
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$6,851.00 |
| Max. Negotiated Rate |
$7,818.20 |
| Rate for Payer: Cash Price |
$4,836.00
|
| Rate for Payer: Health Management Network Commercial |
$6,851.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,818.20
|
|
|
HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE - IMMUNOHISTOCHEM EA ADD
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834102
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$378.25 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: MDX Hawaii PPO |
$431.65
|
|
|
HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE - IMMUNOHISTOCHEM EA ADD
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834102
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$422.75
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$280.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$226.95
|
| Rate for Payer: MDX Hawaii PPO |
$431.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.64
|
| Rate for Payer: University Health Alliance Commercial |
$139.55
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - BUNDLED CHARGE
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3108834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: AlohaCare Medicaid |
$201.27
|
| Rate for Payer: AlohaCare Medicare |
$201.27
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Devoted Health Medicare |
$221.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$251.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.27
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: Humana Medicare |
$201.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,069.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$865.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.27
|
| Rate for Payer: University Health Alliance Commercial |
$193.25
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - BUNDLED CHARGE
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3108834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,443.30 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
|
|
HC IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| 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 IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: AlohaCare Medicaid |
$48.01
|
| Rate for Payer: AlohaCare Medicare |
$48.01
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Devoted Health Medicare |
$52.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$60.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.90
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$48.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.01
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.01
|
| Rate for Payer: University Health Alliance Commercial |
$118.08
|
|
|
HC IMMUNFIX E-PHORSIS/URINE/CSF - IMMUNOFIXATION/IFE URINE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
3028633501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$238.62 |
| Rate for Payer: AlohaCare Medicaid |
$29.35
|
| Rate for Payer: AlohaCare Medicare |
$29.35
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Devoted Health Medicare |
$32.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.35
|
| Rate for Payer: Health Management Network Commercial |
$209.10
|
| Rate for Payer: Humana Medicare |
$29.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$125.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.35
|
| Rate for Payer: MDX Hawaii PPO |
$238.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.35
|
| Rate for Payer: University Health Alliance Commercial |
$75.85
|
|
