|
HC ESCHAROTOMY
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
7611603501
|
|
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 ESCHAROTOMY; EACH ADDITIONAL INCISION
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 16036
|
| Hospital Charge Code |
4501603601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$201.50
|
| Rate for Payer: AlohaCare Medicare |
$306.28
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Devoted Health Medicare |
$338.52
|
| 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 |
$306.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$382.85
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Humana Medicare |
$306.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$306.28
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$306.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$306.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$306.28
|
| Rate for Payer: University Health Alliance Commercial |
$293.75
|
|
|
HC ESCHAROTOMY; EACH ADDITIONAL INCISION
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 16036
|
| Hospital Charge Code |
4501603601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.55 |
| Max. Negotiated Rate |
$390.91 |
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
|
|
HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
7504346001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: AlohaCare Medicaid |
$1,826.50
|
| Rate for Payer: AlohaCare Medicare |
$2,776.28
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Devoted Health Medicare |
$3,068.52
|
| 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 |
$2,776.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,470.35
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Humana Medicare |
$2,776.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,776.28
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,776.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,776.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,776.28
|
| Rate for Payer: University Health Alliance Commercial |
$2,662.67
|
|
|
HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
7504346001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,105.05 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
|
|
HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$46.36
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$51.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$46.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.36
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.36
|
| Rate for Payer: University Health Alliance Commercial |
$18.48
|
|
|
HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
HC EXPLO/DRAIN BREAST ABSCESS
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
7611902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$3,224.00
|
| Rate for Payer: AlohaCare Medicare |
$4,900.48
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$5,416.32
|
| 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 |
$4,900.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,125.60
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$4,900.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,900.48
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,900.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,900.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,900.48
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC EXPLO/DRAIN BREAST ABSCESS
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
7611902001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
|
|
HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
3058537901
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$42.50
|
| Rate for Payer: AlohaCare Medicare |
$64.60
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Devoted Health Medicare |
$71.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.18
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Humana Medicare |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.60
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.60
|
| Rate for Payer: University Health Alliance Commercial |
$26.31
|
|
|
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: AlohaCare Medicaid |
$259.00
|
| Rate for Payer: AlohaCare Medicare |
$393.68
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Devoted Health Medicare |
$435.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$393.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Humana Medicare |
$393.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$393.68
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$393.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$393.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$393.68
|
| Rate for Payer: University Health Alliance Commercial |
$210.97
|
|
|
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.20
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
|
|
HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
|
Facility
|
IP
|
$1,389.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
3108124501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,180.65 |
| Max. Negotiated Rate |
$1,347.33 |
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,250.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,347.33
|
|
|
HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
|
Facility
|
OP
|
$1,389.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
3108124501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$1,347.33 |
| Rate for Payer: AlohaCare Medicaid |
$694.50
|
| Rate for Payer: AlohaCare Medicare |
$1,055.64
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Devoted Health Medicare |
$1,166.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,055.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.51
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: Humana Medicare |
$1,055.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,250.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$708.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,055.64
|
| Rate for Payer: MDX Hawaii PPO |
$1,347.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,055.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,055.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,055.64
|
| Rate for Payer: University Health Alliance Commercial |
$207.20
|
|
|
HC GLUCOSE BLOOD REAGENT STRIP
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3018294801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$31.92
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$35.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.04
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$31.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.92
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.92
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HC GLUCOSE BLOOD REAGENT STRIP
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3018294801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
3018303601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: AlohaCare Medicaid |
$40.50
|
| Rate for Payer: AlohaCare Medicare |
$61.56
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Devoted Health Medicare |
$68.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.71
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.56
|
| Rate for Payer: MDX Hawaii PPO |
$78.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.56
|
| Rate for Payer: University Health Alliance Commercial |
$25.09
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
3018303601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: MDX Hawaii PPO |
$78.57
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$27.36
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$30.24
|
| 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 |
$27.36
|
| 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 |
$27.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.36
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.36
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720503
|
|
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: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4809295001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$1,177.24
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,177.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$1,177.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,177.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4809295001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC HELICOBACTER PYLORI - H PYLORI AB
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
3028667701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.85 |
| 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 |
$20.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.85
|
| 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 |
$20.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.16
|
| Rate for Payer: University Health Alliance Commercial |
$37.52
|
|
|
HC HELICOBACTER PYLORI - H PYLORI AB
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 86677
|
| Hospital Charge Code |
3028667701
|
|
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: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
