|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$57.63
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW - XR FEMUR 1 VW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73551
|
| Hospital Charge Code |
3207355101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS - XR FEMUR 2+ VW
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
3207355201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$67.43
|
|
|
HC RAD TX DEL >=1 MEV COMPLEX
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
3337741201
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$889.95 |
| Max. Negotiated Rate |
$1,015.59 |
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Health Management Network Commercial |
$889.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,015.59
|
|
|
HC RAD TX DEL >=1 MEV COMPLEX
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 77412
|
| Hospital Charge Code |
3337741201
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$1,015.59 |
| Rate for Payer: AlohaCare Medicaid |
$652.74
|
| Rate for Payer: AlohaCare Medicare |
$652.74
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Devoted Health Medicare |
$718.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$76.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$815.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$652.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$86.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$652.74
|
| Rate for Payer: Health Management Network Commercial |
$889.95
|
| Rate for Payer: Humana Medicare |
$652.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$659.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$533.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$652.74
|
| Rate for Payer: MDX Hawaii PPO |
$1,015.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$718.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.74
|
| Rate for Payer: University Health Alliance Commercial |
$371.98
|
|
|
HC RAD TX DEL>=1 MEV INTER
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
3337740701
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$1,015.59 |
| Rate for Payer: AlohaCare Medicaid |
$455.64
|
| Rate for Payer: AlohaCare Medicare |
$455.64
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Devoted Health Medicare |
$501.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$569.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$455.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$455.64
|
| Rate for Payer: Health Management Network Commercial |
$889.95
|
| Rate for Payer: Humana Medicare |
$455.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$659.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$533.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$455.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,015.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$501.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$455.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$455.64
|
| Rate for Payer: University Health Alliance Commercial |
$321.79
|
|
|
HC RAD TX DEL>=1 MEV INTER
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
HCPCS 77407
|
| Hospital Charge Code |
3337740701
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$889.95 |
| Max. Negotiated Rate |
$1,015.59 |
| Rate for Payer: Cash Price |
$628.20
|
| Rate for Payer: Health Management Network Commercial |
$889.95
|
| Rate for Payer: MDX Hawaii PPO |
$1,015.59
|
|
|
HC RAD TX DEL>=1 MEV SIMP
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
3337740201
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$58.71 |
| Max. Negotiated Rate |
$422.92 |
| Rate for Payer: AlohaCare Medicaid |
$120.53
|
| Rate for Payer: AlohaCare Medicare |
$120.53
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Devoted Health Medicare |
$132.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$150.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$63.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.53
|
| Rate for Payer: Health Management Network Commercial |
$370.60
|
| Rate for Payer: Humana Medicare |
$120.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.53
|
| Rate for Payer: MDX Hawaii PPO |
$422.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.53
|
| Rate for Payer: University Health Alliance Commercial |
$250.77
|
|
|
HC RAD TX DEL>=1 MEV SIMP
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
HCPCS 77402
|
| Hospital Charge Code |
3337740201
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$370.60 |
| Max. Negotiated Rate |
$422.92 |
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Health Management Network Commercial |
$370.60
|
| Rate for Payer: MDX Hawaii PPO |
$422.92
|
|
|
HC RBC ABSORPTION EA (ALLO/AUTO)
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 86978
|
| Hospital Charge Code |
3028697801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$500.65 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
|
|
HC RBC ABSORPTION EA (ALLO/AUTO)
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 86978
|
| Hospital Charge Code |
3028697801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: AlohaCare Medicaid |
$69.69
|
| Rate for Payer: AlohaCare Medicare |
$69.69
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Devoted Health Medicare |
$76.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.69
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Humana Medicare |
$69.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.69
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.69
|
| Rate for Payer: University Health Alliance Commercial |
$429.32
|
|
|
HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| 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 |
$16.20
|
| 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 |
$49.52
|
| 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 |
$16.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.27
|
| Rate for Payer: University Health Alliance Commercial |
$1,237.67
|
|
|
HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
3008686001
|
|
Hospital Revenue Code
|
300
|
| 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 RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: AlohaCare Medicaid |
$423.45
|
| Rate for Payer: AlohaCare Medicare |
$423.45
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Devoted Health Medicare |
$465.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$529.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.45
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Humana Medicare |
$423.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,245.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,817.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.45
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.45
|
| Rate for Payer: University Health Alliance Commercial |
$2,597.80
|
|
|
HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
3008687001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,029.40 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
|
|
HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$9.77
|
| Rate for Payer: AlohaCare Medicare |
$9.77
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$10.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.77
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$9.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.77
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.77
|
| Rate for Payer: University Health Alliance Commercial |
$50.88
|
|
|
HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
3008685001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC RBC FROZEN/DEGLYC EA UNIT
|
Facility
|
OP
|
$9,068.00
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
390P903901
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$361.92 |
| Max. Negotiated Rate |
$8,795.96 |
| Rate for Payer: AlohaCare Medicaid |
$361.92
|
| Rate for Payer: AlohaCare Medicare |
$361.92
|
| Rate for Payer: Cash Price |
$5,440.80
|
| Rate for Payer: Cash Price |
$5,440.80
|
| Rate for Payer: Devoted Health Medicare |
$398.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$452.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,614.60
|
| Rate for Payer: Health Management Network Commercial |
$7,707.80
|
| Rate for Payer: Humana Medicare |
$361.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,712.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,624.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.92
|
| Rate for Payer: MDX Hawaii PPO |
$8,795.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$361.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$490.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.92
|
| Rate for Payer: University Health Alliance Commercial |
$6,609.67
|
|
|
HC RBC FROZEN/DEGLYC EA UNIT
|
Facility
|
IP
|
$9,068.00
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
390P903901
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$7,707.80 |
| Max. Negotiated Rate |
$8,795.96 |
| Rate for Payer: Cash Price |
$5,440.80
|
| Rate for Payer: Health Management Network Commercial |
$7,707.80
|
| Rate for Payer: MDX Hawaii PPO |
$8,795.96
|
|
|
HC RBC FROZEN/DEGLYC EA UNIT
|
Facility
|
OP
|
$6,477.00
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
381P903901
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$361.92 |
| Max. Negotiated Rate |
$6,282.69 |
| Rate for Payer: AlohaCare Medicaid |
$361.92
|
| Rate for Payer: AlohaCare Medicare |
$361.92
|
| Rate for Payer: Cash Price |
$3,886.20
|
| Rate for Payer: Cash Price |
$3,886.20
|
| Rate for Payer: Devoted Health Medicare |
$398.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$452.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,153.15
|
| Rate for Payer: Health Management Network Commercial |
$5,505.45
|
| Rate for Payer: Humana Medicare |
$361.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,080.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,303.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$361.92
|
| Rate for Payer: MDX Hawaii PPO |
$6,282.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$398.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$361.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$490.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.92
|
| Rate for Payer: University Health Alliance Commercial |
$4,721.09
|
|
|
HC RBC FROZEN/DEGLYC EA UNIT
|
Facility
|
IP
|
$6,477.00
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
381P903901
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$5,505.45 |
| Max. Negotiated Rate |
$6,282.69 |
| Rate for Payer: Cash Price |
$3,886.20
|
| Rate for Payer: Health Management Network Commercial |
$5,505.45
|
| Rate for Payer: MDX Hawaii PPO |
$6,282.69
|
|
|
HC RBC LEUKOPOOR EA UNIT
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
390P901601
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$2,448.28 |
| Rate for Payer: AlohaCare Medicaid |
$213.81
|
| Rate for Payer: AlohaCare Medicare |
$213.81
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Devoted Health Medicare |
$235.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$267.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,397.80
|
| Rate for Payer: Health Management Network Commercial |
$2,145.40
|
| Rate for Payer: Humana Medicare |
$213.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,590.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,287.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$213.81
|
| Rate for Payer: MDX Hawaii PPO |
$2,448.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.81
|
| Rate for Payer: University Health Alliance Commercial |
$1,839.74
|
|
|
HC RBC LEUKOPOOR EA UNIT
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
390P901601
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$2,145.40 |
| Max. Negotiated Rate |
$2,448.28 |
| Rate for Payer: Cash Price |
$1,514.40
|
| Rate for Payer: Health Management Network Commercial |
$2,145.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,448.28
|
|
|
HC RBC LEUKOPOOR EA UNIT
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
381P901601
|
|
Hospital Revenue Code
|
381
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,748.91 |
| Rate for Payer: AlohaCare Medicaid |
$213.81
|
| Rate for Payer: AlohaCare Medicare |
$213.81
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Devoted Health Medicare |
$235.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$267.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$213.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,712.85
|
| Rate for Payer: Health Management Network Commercial |
$1,532.55
|
| Rate for Payer: Humana Medicare |
$213.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,135.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$919.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$213.81
|
| Rate for Payer: MDX Hawaii PPO |
$1,748.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$235.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$213.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$136.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$213.81
|
| Rate for Payer: University Health Alliance Commercial |
$1,314.21
|
|
