|
HC SALIVARY GLAND FUNCTION EXAM - NM SALIVARY GLAND FUNCTION
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78232
|
| Hospital Charge Code |
3417823201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$116.35 |
| 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 |
$116.35
|
| 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 |
$126.41
|
| 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 |
$116.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$298.72
|
|
|
HC SALIVARY GLAND IMAGING - CT SALIVARY GLAND
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78230
|
| Hospital Charge Code |
3417823001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$72.00 |
| 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 |
$72.00
|
| 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 |
$78.38
|
| 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 |
$72.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$296.26
|
|
|
HC SALIVARY GLAND IMAGING - CT SALIVARY GLAND
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78230
|
| Hospital Charge Code |
3417823001
|
|
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 SALIVARY GLAND IMAGING - NM SALIVARY GLAND
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78230
|
| Hospital Charge Code |
3417823002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$72.00 |
| 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 |
$72.00
|
| 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 |
$78.38
|
| 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 |
$72.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$296.26
|
|
|
HC SALIVARY GLAND IMAGING - NM SALIVARY GLAND
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78230
|
| Hospital Charge Code |
3417823002
|
|
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 SARS-COV-2 COVID-19 ANTIBODY - SARS-COV-2 (SPIKE) AB TL
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
3028676901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$342.41 |
| Rate for Payer: AlohaCare Medicaid |
$42.13
|
| Rate for Payer: AlohaCare Medicare |
$42.13
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Devoted Health Medicare |
$46.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.13
|
| Rate for Payer: Health Management Network Commercial |
$300.05
|
| Rate for Payer: Humana Medicare |
$42.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$222.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$180.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.13
|
| Rate for Payer: MDX Hawaii PPO |
$342.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.13
|
| Rate for Payer: University Health Alliance Commercial |
$257.30
|
|
|
HC SARS-COV-2 COVID-19 ANTIBODY - SARS-COV-2 (SPIKE) AB TL
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
3028676901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$300.05 |
| Max. Negotiated Rate |
$342.41 |
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Health Management Network Commercial |
$300.05
|
| Rate for Payer: MDX Hawaii PPO |
$342.41
|
|
|
HC SARSCOVID19 RAPID ANTIGEN POCT
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
3068781101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$336.59 |
| Rate for Payer: AlohaCare Medicaid |
$41.38
|
| Rate for Payer: AlohaCare Medicare |
$41.38
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Devoted Health Medicare |
$45.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.38
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: Humana Medicare |
$41.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.38
|
| Rate for Payer: MDX Hawaii PPO |
$336.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.38
|
| Rate for Payer: University Health Alliance Commercial |
$252.93
|
|
|
HC SARSCOVID19 RAPID ANTIGEN POCT
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
3068781101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$294.95 |
| Max. Negotiated Rate |
$336.59 |
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Health Management Network Commercial |
$294.95
|
| Rate for Payer: MDX Hawaii PPO |
$336.59
|
|
|
HC SBRT TX DLVRY PER FRCT 1/+ LES
|
Facility
|
OP
|
$6,988.00
|
|
|
Service Code
|
HCPCS 77373
|
| Hospital Charge Code |
3337737301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$6,778.36 |
| Rate for Payer: AlohaCare Medicaid |
$2,112.31
|
| Rate for Payer: AlohaCare Medicare |
$2,112.31
|
| Rate for Payer: Cash Price |
$4,192.80
|
| Rate for Payer: Cash Price |
$4,192.80
|
| Rate for Payer: Devoted Health Medicare |
$2,323.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,268.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,640.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,112.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,494.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,112.31
|
| Rate for Payer: Health Management Network Commercial |
$5,939.80
|
| Rate for Payer: Humana Medicare |
$2,112.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,402.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,563.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,112.31
|
| Rate for Payer: MDX Hawaii PPO |
$6,778.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,323.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,112.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,112.31
|
| Rate for Payer: University Health Alliance Commercial |
$3,425.13
|
|
|
HC SBRT TX DLVRY PER FRCT 1/+ LES
|
Facility
|
IP
|
$6,988.00
|
|
|
Service Code
|
HCPCS 77373
|
| Hospital Charge Code |
3337737301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,939.80 |
| Max. Negotiated Rate |
$6,778.36 |
| Rate for Payer: Cash Price |
$4,192.80
|
| Rate for Payer: Health Management Network Commercial |
$5,939.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,778.36
|
|
|
HC SC-BX BONE TROC/NDL DEEP
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 27041
|
| Hospital Charge Code |
3612704101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,062.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$4,699.95
|
|
|
HC SC-BX BONE TROC/NDL DEEP
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 27041
|
| Hospital Charge Code |
3612704101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC SC-BX LUNG/MEDIA PERCUT N
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
3613240801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,062.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| 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 |
$5,160.40
|
|
|
HC SC-BX LUNG/MEDIA PERCUT N
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 32408
|
| Hospital Charge Code |
3613240801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
3614918501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$1,951.11
|
| Rate for Payer: AlohaCare Medicare |
$1,951.11
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$2,146.22
|
| 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 |
$1,951.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$1,951.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,062.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,951.11
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| 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 |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,951.11
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
3614918501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC SECONDARY ICU PRIVATE ROOM DAILY
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
2060000002
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,781.25 |
| Max. Negotiated Rate |
$8,900.00 |
| Rate for Payer: Cash Price |
$3,375.00
|
| Rate for Payer: Cash Price |
$3,375.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,900.00
|
| Rate for Payer: Health Management Network Commercial |
$4,781.25
|
| Rate for Payer: MDX Hawaii PPO |
$5,456.25
|
| Rate for Payer: University Health Alliance Commercial |
$6,369.00
|
|
|
HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Facility
|
OP
|
$45,131.00
|
|
|
Service Code
|
HCPCS 37186
|
| Hospital Charge Code |
3613718601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$43,777.07 |
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Health Management Network Commercial |
$38,361.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$28,432.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: MDX Hawaii PPO |
$43,777.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.40
|
| Rate for Payer: University Health Alliance Commercial |
$32,895.99
|
|
|
HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Facility
|
IP
|
$45,131.00
|
|
|
Service Code
|
HCPCS 37186
|
| Hospital Charge Code |
3613718601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38,361.35 |
| Max. Negotiated Rate |
$43,777.07 |
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Health Management Network Commercial |
$38,361.35
|
| Rate for Payer: MDX Hawaii PPO |
$43,777.07
|
|
|
HC SENSITIVITY PER ENZYME
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3068718501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
HC SENSITIVITY PER ENZYME
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
3068718501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$4.75
|
| Rate for Payer: AlohaCare Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$5.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.75
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.75
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
HC SERIAL SALIVARY IMAGING - NM SERIAL SALIVARY GLAND
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78231
|
| Hospital Charge Code |
3417823101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.57 |
| 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 |
$104.57
|
| 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 |
$113.26
|
| 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 |
$104.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$288.12
|
|
|
HC SERIAL SALIVARY IMAGING - NM SERIAL SALIVARY GLAND
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78231
|
| Hospital Charge Code |
3417823101
|
|
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 SIGMOIDOSCOPY,BIOPSY - ENDOSCOPY SIGMOID
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
3604533101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,519.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,098.60
|
| Rate for Payer: AlohaCare Medicare |
$1,098.60
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Devoted Health Medicare |
$1,208.46
|
| 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 |
$1,098.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$3,083.80
|
| Rate for Payer: Humana Medicare |
$1,098.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,285.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,098.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,519.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,208.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,098.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,098.60
|
| Rate for Payer: University Health Alliance Commercial |
$2,644.45
|
|
