|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$15.08
|
| Rate for Payer: AlohaCare Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.08
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.08
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86596
|
| Hospital Charge Code |
3028659601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$73.62
|
|
|
HC VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86596
|
| Hospital Charge Code |
3028659601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86021
|
| Hospital Charge Code |
3028602101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$15.05
|
| Rate for Payer: AlohaCare Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$16.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.05
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.05
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HC WEARABLE DEFIB INTERROGATE - CARDIAC DEVICE CHECK - IN PERSON
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 93292
|
| Hospital Charge Code |
4809329201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$44.09
|
| Rate for Payer: AlohaCare Medicare |
$44.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$44.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.09
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.09
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
HC WEARABLE DEFIB INTERROGATE - CARDIAC DEVICE CHECK - IN PERSON
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 93292
|
| Hospital Charge Code |
4809329201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
HC WESTERN BLOT W/INTERP
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
3008418203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$237.65 |
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: MDX Hawaii PPO |
$237.65
|
|
|
HC WESTERN BLOT W/INTERP
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 84182
|
| Hospital Charge Code |
3008418203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$237.65 |
| Rate for Payer: AlohaCare Medicaid |
$29.21
|
| Rate for Payer: AlohaCare Medicare |
$29.21
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Devoted Health Medicare |
$32.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.21
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Humana Medicare |
$29.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.21
|
| Rate for Payer: MDX Hawaii PPO |
$237.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.21
|
| Rate for Payer: University Health Alliance Commercial |
$46.53
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE IGM CSF SO
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
3028678801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: AlohaCare Medicaid |
$16.85
|
| Rate for Payer: AlohaCare Medicare |
$16.85
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$18.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.85
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$16.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.85
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.85
|
| Rate for Payer: University Health Alliance Commercial |
$43.55
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE IGM CSF SO
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
3028678801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
3028678901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: AlohaCare Medicaid |
$14.39
|
| Rate for Payer: AlohaCare Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Devoted Health Medicare |
$15.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Humana Medicare |
$14.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.39
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.39
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
3028678901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.85 |
| Max. Negotiated Rate |
$117.37 |
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: MDX Hawaii PPO |
$117.37
|
|
|
HC WHO W/O JOINTS CF
|
Facility
|
OP
|
$2,149.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
274L390601
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$2,084.53 |
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,504.30
|
| Rate for Payer: Health Management Network Commercial |
$1,826.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,353.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,095.99
|
| Rate for Payer: MDX Hawaii PPO |
$2,084.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$255.64
|
| Rate for Payer: University Health Alliance Commercial |
$1,203.44
|
|
|
HC WHO W/O JOINTS CF
|
Facility
|
IP
|
$2,149.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
274L390601
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,203.44 |
| Max. Negotiated Rate |
$2,084.53 |
| Rate for Payer: Cash Price |
$1,289.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,504.30
|
| Rate for Payer: Health Management Network Commercial |
$1,826.65
|
| Rate for Payer: MDX Hawaii PPO |
$2,084.53
|
| Rate for Payer: University Health Alliance Commercial |
$1,203.44
|
|
|
HC WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
7613660001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$261.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
7613660001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC WRIGHTS STAIN WBC(STOOL) W/INT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720501
|
|
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 WRIGHTS STAIN WBC(STOOL) W/INT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720501
|
|
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 X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| 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 X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 74022
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.39 |
| 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 |
$24.39
|
| 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 |
$26.81
|
| 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 |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$95.72
|
|
|
HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| 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 |
$21.96
|
| 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 |
$24.13
|
| 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 |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$73.74
|
|
|
HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
3207305001
|
|
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 X-RAY ANKLE 2 VW - XR ANKLE 2 VIEWS
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
3207360001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| 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 |
$16.41
|
| 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 |
$17.57
|
| 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 |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
