|
HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
3068720601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: MDX Hawaii PPO |
$48.50
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: AlohaCare Medicaid |
$5.99
|
| Rate for Payer: AlohaCare Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Devoted Health Medicare |
$6.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.99
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.99
|
| Rate for Payer: MDX Hawaii PPO |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.99
|
| Rate for Payer: University Health Alliance Commercial |
$15.48
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MICROSPORIDIA SPORE DET W/INT
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: MDX Hawaii PPO |
$48.50
|
|
|
HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MICROSPORIDIA SPORE DET W/INT
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
3068720701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: AlohaCare Medicaid |
$5.99
|
| Rate for Payer: AlohaCare Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Devoted Health Medicare |
$6.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.99
|
| Rate for Payer: Health Management Network Commercial |
$42.50
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.99
|
| Rate for Payer: MDX Hawaii PPO |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.99
|
| Rate for Payer: University Health Alliance Commercial |
$15.48
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - WET PREP GENITAL
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
3068721001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$5.82
|
| Rate for Payer: AlohaCare Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Devoted Health Medicare |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.82
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.82
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC SMEAR,STAIN,WET MNT,INTERP - WET PREP GENITAL
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
3068721001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
HC SNF WAITLIST ROOM DAILY
|
Facility
|
IP
|
$2,500.00
|
|
| Hospital Charge Code |
1200000003
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,125.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: MDX Hawaii PPO |
$2,425.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685703
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685703
|
|
Hospital Revenue Code
|
402
|
| 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 SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685701
|
|
Hospital Revenue Code
|
402
|
| 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 SPC MED RAD PHYSICS CONS
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
3337737001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
|
HC SPC MED RAD PHYSICS CONS
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
3337737001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$129.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$123.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$271.17
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
3337733101
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$120.68
|
|
|
HC SPECIAL DOSIMETRY
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 77331
|
| Hospital Charge Code |
3337733101
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
|
HC SPECIAL STAINS,GROUP II - SPECIAL STAIN GRP 2 INT/RPT EA
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
3108831302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,238.69 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.18
|
| Rate for Payer: Health Management Network Commercial |
$1,085.45
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$804.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$651.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$1,238.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$144.02
|
|
|
HC SPECIAL STAINS,GROUP II - SPECIAL STAIN GRP 2 INT/RPT EA
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
3108831302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,085.45 |
| Max. Negotiated Rate |
$1,238.69 |
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Health Management Network Commercial |
$1,085.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,238.69
|
|
|
HC SPECIAL STAINS,GROUP I - SPECIAL STAIN GRP 1 INT/RPT EA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
3108831202
|
|
Hospital Revenue Code
|
310
|
| 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 SPECIAL STAINS,GROUP I - SPECIAL STAIN GRP 1 INT/RPT EA
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
3108831202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$61.56
|
| Rate for Payer: AlohaCare Medicare |
$61.56
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$67.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.77
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$76.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.56
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.56
|
| Rate for Payer: University Health Alliance Commercial |
$187.61
|
|
|
HC SPECIAL TREATMENT PROC
|
Facility
|
OP
|
$2,302.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
3337747001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$393.73 |
| Max. Negotiated Rate |
$2,232.94 |
| Rate for Payer: AlohaCare Medicaid |
$652.74
|
| Rate for Payer: AlohaCare Medicare |
$652.74
|
| Rate for Payer: Cash Price |
$1,381.20
|
| Rate for Payer: Cash Price |
$1,381.20
|
| Rate for Payer: Devoted Health Medicare |
$718.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.73
|
| 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 |
$404.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$652.74
|
| Rate for Payer: Health Management Network Commercial |
$1,956.70
|
| Rate for Payer: Humana Medicare |
$652.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,450.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,174.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$652.74
|
| Rate for Payer: MDX Hawaii PPO |
$2,232.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$718.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$652.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$393.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$652.74
|
| Rate for Payer: University Health Alliance Commercial |
$716.76
|
|
|
HC SPECIAL TREATMENT PROC
|
Facility
|
IP
|
$2,302.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
3337747001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,956.70 |
| Max. Negotiated Rate |
$2,232.94 |
| Rate for Payer: Cash Price |
$1,381.20
|
| Rate for Payer: Health Management Network Commercial |
$1,956.70
|
| Rate for Payer: MDX Hawaii PPO |
$2,232.94
|
|
|
HC SPECTROPHOTOMETRY - POTASSIUM FECES SO
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
3018431101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HC SPECTROPHOTOMETRY - POTASSIUM FECES SO
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
3018431101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$8.10
|
| Rate for Payer: AlohaCare Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$8.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$8.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.10
|
| Rate for Payer: University Health Alliance Commercial |
$18.07
|
|
|
HC SPECTROPHOTOMETRY - SPECTROPHOTOMETRY NOS SO
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
3018431102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|