|
HC HEMATOCRIT - HEMATOCRIT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.20
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HC HEMATOCRIT - HEMATOCRIT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501401
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HC HEMATOCRIT - POCT HEMATOCRIT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501404
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HC HEMATOCRIT - POCT HEMATOCRIT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
3058501404
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.20
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HC HEMOGLOBIN - HEMOGLOBIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.20
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HC HEMOGLOBIN - HEMOGLOBIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HC HEMOGLOBIN - POCT HEMOGLOBIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501803
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.20
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HC HEMOGLOBIN - POCT HEMOGLOBIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
3058501803
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$34.50
|
| Rate for Payer: AlohaCare Medicare |
$52.44
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$57.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$52.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.44
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.44
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$79.04
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$87.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.39
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$79.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.04
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.04
|
| Rate for Payer: University Health Alliance Commercial |
$32.02
|
|
|
HC HEPATITIS A ANTIBODY HAAB - HEPATITIS A ANTIBODY, TOTAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
3028670801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$68.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$75.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$68.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.40
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: AlohaCare Medicaid |
$200.00
|
| Rate for Payer: AlohaCare Medicare |
$304.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Devoted Health Medicare |
$336.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$304.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.63
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Humana Medicare |
$304.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$304.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$304.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$304.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$304.00
|
| Rate for Payer: University Health Alliance Commercial |
$123.10
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| 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 ABD |
$16.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.77
|
| 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 |
$16.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.24
|
| Rate for Payer: University Health Alliance Commercial |
$30.41
|
|
|
HC HEP B CORE AB TEST, IGM - HEPATITIS B CORE ANTIBODY, IGM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
3028670501
|
|
Hospital Revenue Code
|
302
|
| 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 HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
3028670401
|
|
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 HEP B CORE AB TEST, TOTAL - HEPATITIS B CORE ANTIBODY, TOTAL
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
3028670401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| 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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.76
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
3028630801
|
|
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 HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
3028630801
|
|
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 HHH CAH SNF ROOM DAILY
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
1200000001
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$825.17 |
| Max. Negotiated Rate |
$2,701.60 |
| Rate for Payer: AlohaCare Medicaid |
$825.17
|
| Rate for Payer: AlohaCare Medicare |
$2,456.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Devoted Health Medicare |
$2,701.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$825.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,456.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$825.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Humana Medicare |
$2,456.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$825.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,456.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,456.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$825.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,456.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
HC HHH ICF ROOM DAILY
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
1210000001
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$797.30 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$825.17
|
| Rate for Payer: AlohaCare Medicare |
$1,564.00
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Devoted Health Medicare |
$1,720.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$825.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,564.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$825.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$797.30
|
| Rate for Payer: Humana Medicare |
$1,564.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$844.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$825.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,564.00
|
| Rate for Payer: MDX Hawaii PPO |
$909.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,564.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$825.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,564.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
HC HHH SNF ROOM DAILY
|
Facility
|
IP
|
$1,063.00
|
|
| Hospital Charge Code |
1500000001
|
|
Hospital Revenue Code
|
150
|
| Min. Negotiated Rate |
$825.17 |
| Max. Negotiated Rate |
$2,701.60 |
| Rate for Payer: AlohaCare Medicaid |
$825.17
|
| Rate for Payer: AlohaCare Medicare |
$2,456.00
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Devoted Health Medicare |
$2,701.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$825.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,456.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$825.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$903.55
|
| Rate for Payer: Humana Medicare |
$2,456.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$956.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$825.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,456.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,031.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$825.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,456.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$825.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,456.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
