|
HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
3028680001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: AlohaCare Medicaid |
$15.91
|
| Rate for Payer: AlohaCare Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Devoted Health Medicare |
$17.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.91
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$15.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.91
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.91
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
3028680001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID UPTAKE STIMULATION SUPPRES
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
3417801401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$92.23 |
| 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 |
$95.18
|
| 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 |
$92.23
|
| 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 |
$165.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$511.34
|
|
|
HC THYROID IMAGING W/BLOOD FLOW - NM THYROID UPTAKE STIMULATION SUPPRES
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
3417801401
|
|
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 THYROID MET IMAGING BODY - NM THYROID WHOLE BODY TUMOR
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78018
|
| Hospital Charge Code |
3417801801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$178.75 |
| 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 |
$178.75
|
| 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 |
$194.22
|
| 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 |
$178.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$617.66
|
|
|
HC THYROID MET IMAGING BODY - NM THYROID WHOLE BODY TUMOR
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78018
|
| Hospital Charge Code |
3417801801
|
|
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 THYROID MET IMAGING - NM THYROID TUMOR METASTASES LIMITED
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78015
|
| Hospital Charge Code |
3417801501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$84.72 |
| 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 |
$84.72
|
| 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 |
$92.23
|
| 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 |
$84.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$377.18
|
|
|
HC THYROID MET IMAGING - NM THYROID TUMOR METASTASES LIMITED
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78015
|
| Hospital Charge Code |
3417801501
|
|
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 TISSUE CULT BONE MARRO SO
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
3118823701
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$125.68 |
| Max. Negotiated Rate |
$1,169.82 |
| Rate for Payer: AlohaCare Medicaid |
$143.75
|
| Rate for Payer: AlohaCare Medicare |
$143.75
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Devoted Health Medicare |
$158.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$179.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.75
|
| Rate for Payer: Health Management Network Commercial |
$1,025.10
|
| Rate for Payer: Humana Medicare |
$143.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$759.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$615.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,169.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.75
|
| Rate for Payer: University Health Alliance Commercial |
$326.47
|
|
|
HC TISSUE CULT BONE MARRO SO
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
3118823701
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$1,025.10 |
| Max. Negotiated Rate |
$1,169.82 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Health Management Network Commercial |
$1,025.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,169.82
|
|
|
HC TISSUE CULTURE, LYMPHOCYTE - TISSUE CULT LYMPHOCYTE SO
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
3118823001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$116.49
|
| Rate for Payer: AlohaCare Medicare |
$116.49
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Devoted Health Medicare |
$128.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$161.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$145.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$116.49
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$116.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$615.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.49
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$161.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.49
|
| Rate for Payer: University Health Alliance Commercial |
$301.12
|
|
|
HC TISSUE CULTURE, LYMPHOCYTE - TISSUE CULT LYMPHOCYTE SO
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 88230
|
| Hospital Charge Code |
3118823001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$586.20
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
HC TISSUE EXAM BY KOH - KOH PREP
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
3068722001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$4.27
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$4.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC TISSUE EXAM BY KOH - KOH PREP
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
3068722001
|
|
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 TISSUE INSITU HYBRIDIZATI EA
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
3108836501
|
|
Hospital Revenue Code
|
310
|
| 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 TISSUE INSITU HYBRIDIZATI EA
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
3108836501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.74 |
| 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 |
$82.14
|
| 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 |
$52.74
|
| 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 |
$82.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.27
|
| Rate for Payer: University Health Alliance Commercial |
$296.04
|
|
|
HC TISSUE TGLUTAMINASE IGA S
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3028636401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$12.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.53
|
| Rate for Payer: University Health Alliance Commercial |
$70.70
|
|
|
HC TISSUE TGLUTAMINASE IGA S
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3028636401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
HC TISSUE TGLUTAMINASE IGG SO
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3018636401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
HC TISSUE TGLUTAMINASE IGG SO
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
3018636401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$12.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.53
|
| Rate for Payer: University Health Alliance Commercial |
$70.70
|
|
|
HC TOE(S) MIN 2V BILAT
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
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 TOE(S) MIN 2V BILAT
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.91 |
| 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 |
$13.91
|
| 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 |
$14.94
|
| 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 |
$13.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.35
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: AlohaCare Medicaid |
$16.30
|
| Rate for Payer: AlohaCare Medicare |
$16.30
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.30
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$16.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.30
|
| Rate for Payer: University Health Alliance Commercial |
$42.14
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION 1 HOUR
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HC TOTAL CORTISOL - ACTH STIMULATION 30 MINUTES
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 82533
|
| Hospital Charge Code |
3018253303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: AlohaCare Medicaid |
$16.30
|
| Rate for Payer: AlohaCare Medicare |
$16.30
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$17.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.30
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$16.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.30
|
| Rate for Payer: University Health Alliance Commercial |
$42.14
|
|
