|
HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
3028635701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: AlohaCare Medicaid |
$37.73
|
| Rate for Payer: AlohaCare Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Devoted Health Medicare |
$41.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.62
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.73
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$199.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.73
|
| Rate for Payer: University Health Alliance Commercial |
$97.50
|
|
|
HC NK CELLS, TOTAL COUNT - NATURAL KILLER CELL COUNT
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 86357
|
| Hospital Charge Code |
3028635701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
|
|
HC NMO/AQP4 AB SCRN SO
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 86053
|
| Hospital Charge Code |
3028605301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
|
|
HC NMO/AQP4 AB SCRN SO
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 86053
|
| Hospital Charge Code |
3028605301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: AlohaCare Medicaid |
$37.73
|
| Rate for Payer: AlohaCare Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Devoted Health Medicare |
$41.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.73
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$199.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.73
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.73
|
| Rate for Payer: University Health Alliance Commercial |
$231.06
|
|
|
HC NSE SERUM SO QT EA
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
3028631601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
HC NSE SERUM SO QT EA
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
3028631601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$20.81
|
| Rate for Payer: AlohaCare Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$22.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.81
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - CENTROMERE NUC AG AB (ACENT)
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - CENTROMERE NUC AG AB (ACENT)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY -ENA AB EA SO
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY -ENA AB EA SO
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ENA EA AB
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ENA EA AB
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY -JO-1 AB SO
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY -JO-1 AB SO
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA AB EA SCL70
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SCLERODERMA AB EA SCL70
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB - SJOGRENS AB EA
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.93
|
| Rate for Payer: AlohaCare Medicare |
$17.93
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.93
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB - SJOGRENS AB EA
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC NUCLEAR RX INTRA-ARTERIAL - NM RADIOPHARM THERAPY BY INT-ART PARTIC
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 79445
|
| Hospital Charge Code |
3407944501
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$1,081.55 |
| Rate for Payer: AlohaCare Medicaid |
$275.65
|
| Rate for Payer: AlohaCare Medicare |
$275.65
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Devoted Health Medicare |
$303.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$176.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$344.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.65
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: Humana Medicare |
$275.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,081.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$303.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.65
|
| Rate for Payer: University Health Alliance Commercial |
$812.72
|
|
|
HC NUCLEAR RX INTRA-ARTERIAL - NM RADIOPHARM THERAPY BY INT-ART PARTIC
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 79445
|
| Hospital Charge Code |
3407944501
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$947.75 |
| Max. Negotiated Rate |
$1,081.55 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,081.55
|
|
|
HC NUCLEAR RX IV ADMIN - NM BONE TREATMENT THERAPY
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
3427910101
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$82.79 |
| Max. Negotiated Rate |
$1,081.55 |
| Rate for Payer: AlohaCare Medicaid |
$275.65
|
| Rate for Payer: AlohaCare Medicare |
$275.65
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Devoted Health Medicare |
$303.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$344.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.65
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: Humana Medicare |
$275.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,081.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$303.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.65
|
| Rate for Payer: University Health Alliance Commercial |
$351.98
|
|
|
HC NUCLEAR RX IV ADMIN - NM BONE TREATMENT THERAPY
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 79101
|
| Hospital Charge Code |
3427910101
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$947.75 |
| Max. Negotiated Rate |
$1,081.55 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,081.55
|
|
|
HC NUCLEAR THERAPY, ORAL
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
3427900508
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$82.79 |
| Max. Negotiated Rate |
$1,081.55 |
| Rate for Payer: AlohaCare Medicaid |
$275.65
|
| Rate for Payer: AlohaCare Medicare |
$275.65
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Devoted Health Medicare |
$303.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$344.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$275.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$91.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.65
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: Humana Medicare |
$275.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$568.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,081.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$303.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$275.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$275.65
|
| Rate for Payer: University Health Alliance Commercial |
$326.89
|
|
|
HC NUCLEAR THERAPY, ORAL
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 79005
|
| Hospital Charge Code |
3427900508
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$947.75 |
| Max. Negotiated Rate |
$1,081.55 |
| Rate for Payer: Cash Price |
$669.00
|
| Rate for Payer: Health Management Network Commercial |
$947.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,081.55
|
|
|
HC NURSERY 3 ROOM DAILY
|
Facility
|
IP
|
$3,125.00
|
|
| Hospital Charge Code |
1730000001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$3,031.25 |
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,656.25
|
| Rate for Payer: MDX Hawaii PPO |
$3,031.25
|
| Rate for Payer: University Health Alliance Commercial |
$1,875.00
|
|
