|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION AEROSOL SINGLE
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857901
|
|
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 LUNG VENTILATION IMAGING - NM LUNG VENTILATION GASEOUS
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.69 |
| 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 |
$104.69
|
| 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 |
$142.76
|
| 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 |
$104.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$399.79
|
|
|
HC LUNG VENTILATION IMAGING - NM LUNG VENTILATION GASEOUS
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78579
|
| Hospital Charge Code |
3417857903
|
|
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 LUNG VENTILAT&PERFUS IMAGING - NM LUNG VENTILATION PERFUSION
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
3417858201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$188.03 |
| 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 |
$188.03
|
| 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 |
$256.07
|
| 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 |
$188.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$818.29
|
|
|
HC LUNG VENTILAT&PERFUS IMAGING - NM LUNG VENTILATION PERFUSION
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78582
|
| Hospital Charge Code |
3417858201
|
|
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 LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3028661802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$138.71 |
| Rate for Payer: AlohaCare Medicaid |
$17.03
|
| Rate for Payer: AlohaCare Medicare |
$17.03
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$18.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.03
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Humana Medicare |
$17.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.03
|
| Rate for Payer: MDX Hawaii PPO |
$138.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.03
|
| Rate for Payer: University Health Alliance Commercial |
$44.03
|
|
|
HC LYME DISEASE ANTIBODY - B. BURGDORFERI ANTIBODIES
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
3028661802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$138.71 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: MDX Hawaii PPO |
$138.71
|
|
|
HC LYMPHANGIO EXTREM UNILAT
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 75801
|
| Hospital Charge Code |
3207580101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.44 |
| Max. Negotiated Rate |
$2,982.75 |
| Rate for Payer: AlohaCare Medicaid |
$741.06
|
| Rate for Payer: AlohaCare Medicare |
$741.06
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Devoted Health Medicare |
$815.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$178.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$926.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$741.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$193.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$741.06
|
| Rate for Payer: Health Management Network Commercial |
$2,613.75
|
| Rate for Payer: Humana Medicare |
$741.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,937.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,568.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$741.06
|
| Rate for Payer: MDX Hawaii PPO |
$2,982.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$815.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$741.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$741.06
|
| Rate for Payer: University Health Alliance Commercial |
$2,241.37
|
|
|
HC LYMPHANGIO EXTREM UNILAT
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 75801
|
| Hospital Charge Code |
3207580101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,613.75 |
| Max. Negotiated Rate |
$2,982.75 |
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Health Management Network Commercial |
$2,613.75
|
| Rate for Payer: MDX Hawaii PPO |
$2,982.75
|
|
|
HC LYMPHATICS & LYMPH GLANDS IMAGING
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3417819501
|
|
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 LYMPHATICS & LYMPH GLANDS IMAGING
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78195
|
| Hospital Charge Code |
3417819501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$157.85 |
| 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 |
$162.90
|
| 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 |
$157.85
|
| 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 |
$162.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$616.24
|
|
|
HC MACROSCOPIC EXAM, PARASITE - PARASITE IDENTIFICATION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
3068716901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$4.31
|
| Rate for Payer: AlohaCare Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$4.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.31
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$4.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.31
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.31
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC MACROSCOPIC EXAM, PARASITE - PARASITE IDENTIFICATION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87169
|
| Hospital Charge Code |
3068716901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC MAGNETIC IMAGE BONE MARROW - MR BONE MARROW WO IV CONTRAST
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 77084
|
| Hospital Charge Code |
6147708401
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$281.87 |
| 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 |
$358.66
|
| 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 |
$401.21
|
| 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 |
$358.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$788.21
|
|
|
HC MAGNETIC IMAGE BONE MARROW - MR BONE MARROW WO IV CONTRAST
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 77084
|
| Hospital Charge Code |
6147708401
|
|
Hospital Revenue Code
|
614
|
| 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 MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$24.11
|
| Rate for Payer: AlohaCare Medicare |
$24.11
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$26.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.11
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$24.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.11
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.11
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
HC MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 83789
|
| Hospital Charge Code |
3018378901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
HC MEAS,POST-VOID RES,US,NON-IMAGING
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
7615179801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$69.69
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| 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 |
$69.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$69.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.69
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC MEAS,POST-VOID RES,US,NON-IMAGING
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
7615179801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS
|
Facility
|
IP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
3603659501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,647.10 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
|
|
HC MECH REMOV PERICATH OBSTR CV DEV VIA VEN ACCESS
|
Facility
|
OP
|
$12,526.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
3603659501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$12,150.22 |
| Rate for Payer: AlohaCare Medicaid |
$3,730.07
|
| Rate for Payer: AlohaCare Medicare |
$3,730.07
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Cash Price |
$7,515.60
|
| Rate for Payer: Devoted Health Medicare |
$4,103.08
|
| 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 |
$3,730.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$10,647.10
|
| Rate for Payer: Humana Medicare |
$3,730.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,891.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,730.07
|
| Rate for Payer: MDX Hawaii PPO |
$12,150.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,103.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,730.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,730.07
|
| Rate for Payer: University Health Alliance Commercial |
$9,130.20
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$10.56
|
| Rate for Payer: AlohaCare Medicare |
$10.56
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$11.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.56
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$10.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.56
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.56
|
| Rate for Payer: University Health Alliance Commercial |
$27.32
|
|
|
HC M GENITALIUM AMP PROBE SO
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87563
|
| Hospital Charge Code |
3068756301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$33.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$214.30
|
|
|
HC M GENITALIUM AMP PROBE SO
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87563
|
| Hospital Charge Code |
3068756301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
