|
HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
9189616101
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HC CAREGIVER TRAING 1ST 30 MIN
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 97550
|
| Hospital Charge Code |
9429755001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HC CAREGIVER TRAING 1ST 30 MIN
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 97550
|
| Hospital Charge Code |
9429755001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$46.47 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$180.88
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Devoted Health Medicare |
$199.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$180.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$226.10
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$180.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$180.88
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$180.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$180.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$180.88
|
| Rate for Payer: University Health Alliance Commercial |
$173.48
|
|
|
HC CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
4503651001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.15 |
| Max. Negotiated Rate |
$290.03 |
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.10
|
| Rate for Payer: MDX Hawaii PPO |
$290.03
|
|
|
HC CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
4503651001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$149.50
|
| Rate for Payer: AlohaCare Medicare |
$227.24
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Devoted Health Medicare |
$251.16
|
| 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 |
$227.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$284.05
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Humana Medicare |
$227.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$227.24
|
| Rate for Payer: MDX Hawaii PPO |
$290.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$227.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$227.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$227.24
|
| Rate for Payer: University Health Alliance Commercial |
$217.94
|
|
|
HC CATH RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP
|
Facility
|
OP
|
$16,000.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
4819345301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$15,520.00 |
| Rate for Payer: AlohaCare Medicaid |
$8,000.00
|
| Rate for Payer: AlohaCare Medicare |
$12,160.00
|
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Devoted Health Medicare |
$13,440.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,140.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12,160.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15,200.00
|
| Rate for Payer: Health Management Network Commercial |
$13,600.00
|
| Rate for Payer: Humana Medicare |
$12,160.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,400.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8,160.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$12,160.00
|
| Rate for Payer: MDX Hawaii PPO |
$15,520.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12,160.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$12,160.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$12,160.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,662.40
|
|
|
HC CATH RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP
|
Facility
|
IP
|
$16,000.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
4819345301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,600.00 |
| Max. Negotiated Rate |
$15,520.00 |
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Health Management Network Commercial |
$13,600.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,400.00
|
| Rate for Payer: MDX Hawaii PPO |
$15,520.00
|
|
|
HC C DIFF AMP PROBE/CDT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: AlohaCare Medicaid |
$156.50
|
| Rate for Payer: AlohaCare Medicare |
$237.88
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$262.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.27
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Humana Medicare |
$237.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.88
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.88
|
| Rate for Payer: University Health Alliance Commercial |
$93.00
|
|
|
HC C DIFF AMP PROBE/CDT
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
|
|
HC C DIFF AMP PROBE/TCDB
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$266.05 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
|
|
HC C DIFF AMP PROBE/TCDB
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: AlohaCare Medicaid |
$156.50
|
| Rate for Payer: AlohaCare Medicare |
$237.88
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$262.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.27
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Humana Medicare |
$237.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.88
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.88
|
| Rate for Payer: University Health Alliance Commercial |
$93.00
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
IP
|
$2,656.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
4505171001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,257.60 |
| Max. Negotiated Rate |
$2,576.32 |
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,390.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,576.32
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$2,656.00
|
|
|
Service Code
|
HCPCS 51710
|
| Hospital Charge Code |
4505171001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,576.32 |
| Rate for Payer: AlohaCare Medicaid |
$1,328.00
|
| Rate for Payer: AlohaCare Medicare |
$2,018.56
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Devoted Health Medicare |
$2,231.04
|
| 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 |
$2,018.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,523.20
|
| Rate for Payer: Health Management Network Commercial |
$2,257.60
|
| Rate for Payer: Humana Medicare |
$2,018.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,390.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,018.56
|
| Rate for Payer: MDX Hawaii PPO |
$2,576.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,018.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,018.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,018.56
|
| Rate for Payer: University Health Alliance Commercial |
$1,935.96
|
|
|
HC CHG COLLECTION VENOUS BLOOD, VENIPUNCTURE - DRAW CHARGE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
|
|
HC CHG COLLECTION VENOUS BLOOD, VENIPUNCTURE - DRAW CHARGE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
3003641501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: AlohaCare Medicaid |
$38.00
|
| Rate for Payer: AlohaCare Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Devoted Health Medicare |
$63.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.20
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Humana Medicare |
$57.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.76
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.76
|
| Rate for Payer: University Health Alliance Commercial |
$55.40
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| 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 |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| 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 |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.88
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE URINE
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470301
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUAL - HCG QUAL SERUM
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| 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 |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| 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 |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.88
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HC CHORIONIC GONADOTROPIN, QUAL - HCG QUAL SERUM
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
3018470302
|
|
Hospital Revenue Code
|
301
|
| 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 CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| 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: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
3018470201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$95.76
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Devoted Health Medicare |
$105.84
|
| 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 |
$95.76
|
| 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 |
$95.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.76
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.76
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA AMP PROBE
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$223.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$246.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$223.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$223.44
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC CHYLMD TRACH, DNA, AMP PROBE - CHLAMYDIA AMP PROBE
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
3068749102
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC CLOSED RX ACETABULAR FX
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
7612722001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$710.60
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Devoted Health Medicare |
$785.40
|
| 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 |
$710.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$710.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$710.60
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$710.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$710.60
|
| Rate for Payer: University Health Alliance Commercial |
$681.52
|
|
|
HC CLOSED RX ACETABULAR FX
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
7612722001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
