|
HC CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
4501202101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC CLOZAPINE
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
3018015901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: AlohaCare Medicaid |
$84.50
|
| Rate for Payer: AlohaCare Medicare |
$128.44
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$141.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.15
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Humana Medicare |
$128.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.44
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.44
|
| Rate for Payer: University Health Alliance Commercial |
$123.18
|
|
|
HC CLOZAPINE
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 80159
|
| Hospital Charge Code |
3018015901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
|
|
HC COG SKILL DEV ADDL 15 MIN
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
4309713001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HC COG SKILL DEV ADDL 15 MIN
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
4309713001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.52 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$75.24
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Devoted Health Medicare |
$83.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.05
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$75.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.24
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.24
|
| Rate for Payer: University Health Alliance Commercial |
$72.16
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - PTH RELATED POLYPEPTID QT SO
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC - PTH RELATED POLYPEPTID QT SO
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$153.52
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$169.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.09
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$153.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.52
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.52
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$84.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$76.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.76
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.76
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLEMENT, ANTIGEN - C3 COMPLEMENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616002
|
|
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: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616003
|
|
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: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC COMPLEMENT, ANTIGEN - C4 COMPLEMENT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
3028616003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$84.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$76.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.76
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.76
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: AlohaCare Medicaid |
$32.50
|
| Rate for Payer: AlohaCare Medicare |
$49.40
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$54.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$49.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Humana Medicare |
$49.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.40
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.40
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
HC COMPLETE CBC & AUTO DIFF WBC - ADDITIONAL CHARGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
3058502501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$55.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.50
|
| Rate for Payer: MDX Hawaii PPO |
$63.05
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.60
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
|
|
HC COMPLETE CBC - CBC
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: AlohaCare Medicaid |
$27.00
|
| Rate for Payer: AlohaCare Medicare |
$41.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$45.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Humana Medicare |
$41.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.04
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.04
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
OP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: AlohaCare Medicaid |
$5,695.00
|
| Rate for Payer: AlohaCare Medicare |
$8,656.40
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Devoted Health Medicare |
$9,567.60
|
| 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 |
$8,656.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10,820.50
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Humana Medicare |
$8,656.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,251.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$8,656.40
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8,656.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$8,656.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$8,656.40
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
IP
|
$11,390.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
7611018001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9,681.50 |
| Max. Negotiated Rate |
$11,048.30 |
| Rate for Payer: Cash Price |
$6,834.00
|
| Rate for Payer: Health Management Network Commercial |
$9,681.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,251.00
|
| Rate for Payer: MDX Hawaii PPO |
$11,048.30
|
|
|
HC CONCENTRATION INF AGNT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
HC CONCENTRATION INF AGNT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$42.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$47.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.68
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$42.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.56
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.56
|
| Rate for Payer: University Health Alliance Commercial |
$17.26
|
|
|
HC CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$462.00
|
| Rate for Payer: AlohaCare Medicare |
$702.24
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$776.16
|
| 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 |
$702.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$702.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$702.24
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$702.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$702.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$702.24
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASAL PACKS AND/OR CAUTERY, ANY METHOD; INITIAL
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 30906
|
| Hospital Charge Code |
4503090601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC C-REACTIVE PROTEIN - C-REACTIVE PROTEIN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
3028614001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$32.68
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$36.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$32.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.68
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.68
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HC CRITICAL CARE, ADDL 30 MIN
|
Facility
|
OP
|
$2,368.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
4509929201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$2,296.96 |
| Rate for Payer: AlohaCare Medicaid |
$1,184.00
|
| Rate for Payer: AlohaCare Medicare |
$1,799.68
|
| Rate for Payer: Cash Price |
$1,420.80
|
| Rate for Payer: Cash Price |
$1,420.80
|
| Rate for Payer: Devoted Health Medicare |
$1,989.12
|
| 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 |
$1,799.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,249.60
|
| Rate for Payer: Health Management Network Commercial |
$2,012.80
|
| Rate for Payer: Humana Medicare |
$1,799.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,131.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,799.68
|
| Rate for Payer: MDX Hawaii PPO |
$2,296.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,799.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,799.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,799.68
|
| Rate for Payer: University Health Alliance Commercial |
$1,726.04
|
|
|
HC CRITICAL CARE, ADDL 30 MIN
|
Facility
|
IP
|
$2,368.00
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
4509929201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,012.80 |
| Max. Negotiated Rate |
$2,296.96 |
| Rate for Payer: Cash Price |
$1,420.80
|
| Rate for Payer: Health Management Network Commercial |
$2,012.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,131.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,296.96
|
|
