|
HAND REST ORHTOSIS RIGHT REG
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$203.68
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$225.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$203.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.68
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.68
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT SM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$203.68
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$225.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$203.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$203.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$203.68
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$203.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$203.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$203.68
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT SM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HARMONIC ACE 8MM IS4000 480275
|
Facility
|
OP
|
$1,717.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$858.50 |
| Max. Negotiated Rate |
$1,665.49 |
| Rate for Payer: AlohaCare Medicaid |
$858.50
|
| Rate for Payer: AlohaCare Medicare |
$1,304.92
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Devoted Health Medicare |
$1,442.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,304.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,631.15
|
| Rate for Payer: Health Management Network Commercial |
$1,459.45
|
| Rate for Payer: Humana Medicare |
$1,304.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,545.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$875.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,304.92
|
| Rate for Payer: MDX Hawaii PPO |
$1,665.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,304.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,304.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,304.92
|
| Rate for Payer: University Health Alliance Commercial |
$1,251.52
|
|
|
HARMONIC ACE 8MM IS4000 480275
|
Facility
|
IP
|
$1,717.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,459.45 |
| Max. Negotiated Rate |
$1,665.49 |
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Health Management Network Commercial |
$1,459.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,545.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,665.49
|
|
|
HARVESTER QUADPRO AR-2386-10
|
Facility
|
OP
|
$1,562.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$781.00 |
| Max. Negotiated Rate |
$1,515.14 |
| Rate for Payer: AlohaCare Medicaid |
$781.00
|
| Rate for Payer: AlohaCare Medicare |
$1,187.12
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Devoted Health Medicare |
$1,312.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,187.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,483.90
|
| Rate for Payer: Health Management Network Commercial |
$1,327.70
|
| Rate for Payer: Humana Medicare |
$1,187.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,405.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$796.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,187.12
|
| Rate for Payer: MDX Hawaii PPO |
$1,515.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,187.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,187.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,187.12
|
| Rate for Payer: University Health Alliance Commercial |
$1,138.54
|
|
|
HARVESTER QUADPRO AR-2386-10
|
Facility
|
IP
|
$1,562.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,327.70 |
| Max. Negotiated Rate |
$1,515.14 |
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Health Management Network Commercial |
$1,327.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,405.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,515.14
|
|
|
HB OBSERVATION CARVE-OUT - CARDIOLOGY
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037804
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: AlohaCare Medicaid |
$87.00
|
| Rate for Payer: AlohaCare Medicare |
$132.24
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$146.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,200.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.30
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Humana Medicare |
$132.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.24
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.24
|
| Rate for Payer: University Health Alliance Commercial |
$126.83
|
|
|
HB OBSERVATION CARVE-OUT - CARDIOLOGY
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037804
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
|
|
HC AGENT NOS ASSAY W/OPTIC - CAMPY ANTIGEN DIRECT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$102.60
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$113.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$102.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC AGENT NOS ASSAY W/OPTIC - CAMPY ANTIGEN DIRECT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 1
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 1
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$102.60
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$113.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$102.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 2
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 2
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$102.60
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$113.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$102.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC ALPHA-FETOPROTEIN, SERUM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$107.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$118.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.77
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$107.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.16
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.16
|
| Rate for Payer: University Health Alliance Commercial |
$43.36
|
|
|
HC ALPHA-FETOPROTEIN, SERUM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
3018210501
|
|
Hospital Revenue Code
|
301
|
| 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: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
450
|
| 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: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$389.88
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$430.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$389.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.88
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.88
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
7504660801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,446.41 |
| Rate for Payer: AlohaCare Medicaid |
$1,776.50
|
| Rate for Payer: AlohaCare Medicare |
$2,700.28
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Devoted Health Medicare |
$2,984.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,700.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,375.35
|
| Rate for Payer: Health Management Network Commercial |
$3,020.05
|
| Rate for Payer: Humana Medicare |
$2,700.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,197.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,700.28
|
| Rate for Payer: MDX Hawaii PPO |
$3,446.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,700.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,700.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,700.28
|
| Rate for Payer: University Health Alliance Commercial |
$2,589.78
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
IP
|
$3,553.00
|
|
|
Service Code
|
HCPCS 46608
|
| Hospital Charge Code |
7504660801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,020.05 |
| Max. Negotiated Rate |
$3,446.41 |
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Health Management Network Commercial |
$3,020.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,197.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,446.41
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTIBILITY CHARGE
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$47.88
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$52.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.48
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$47.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.88
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.88
|
| Rate for Payer: University Health Alliance Commercial |
$17.82
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTIBILITY CHARGE
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718604
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: AlohaCare Medicaid |
$36.50
|
| Rate for Payer: AlohaCare Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Devoted Health Medicare |
$61.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Humana Medicare |
$55.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.48
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.48
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HC ANTIBIOTIC SENS,MIC,EACH - SENSITIVITY MIC PER PLATE
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
3068718604
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.05 |
| Max. Negotiated Rate |
$70.81 |
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Health Management Network Commercial |
$62.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.70
|
| Rate for Payer: MDX Hawaii PPO |
$70.81
|
|
