|
HC HIV 1/2 AG AB W/RFX W/BLOT
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
3068738902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.08 |
| 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 |
$34.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.08
|
| 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 |
$34.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.52
|
| Rate for Payer: University Health Alliance Commercial |
$63.12
|
|
|
HC HIV 1/2 AG AB W/RFX W/BLOT
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
3068738902
|
|
Hospital Revenue Code
|
306
|
| 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 HSV, DNA, AMP PROBE - EC HSV 1 AMP PROBE CSF/SWAB
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752902
|
|
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 |
$46.44
|
| 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 |
$48.76
|
| 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 |
$46.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC HSV, DNA, AMP PROBE - EC HSV 1 AMP PROBE CSF/SWAB
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752902
|
|
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 HSV, DNA, AMP PROBE - EC HSV 2 AMP PROB CSF/SWAB
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752903
|
|
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 |
$46.44
|
| 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 |
$48.76
|
| 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 |
$46.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC HSV, DNA, AMP PROBE - EC HSV 2 AMP PROB CSF/SWAB
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752903
|
|
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 HSV, DNA, AMP PROBE - HSV SUBTYPE BLD/OTHER SO
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752901
|
|
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 HSV, DNA, AMP PROBE - HSV SUBTYPE BLD/OTHER SO
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
3068752901
|
|
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 |
$46.44
|
| 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 |
$48.76
|
| 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 |
$46.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$66.12
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Devoted Health Medicare |
$73.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.33
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$66.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.12
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.12
|
| Rate for Payer: University Health Alliance Commercial |
$26.70
|
|
|
HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HEP C QUANT SO
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
3068752201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$348.23 |
| Rate for Payer: AlohaCare Medicaid |
$179.50
|
| Rate for Payer: AlohaCare Medicare |
$272.84
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Devoted Health Medicare |
$301.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$53.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$272.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.84
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Humana Medicare |
$272.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$183.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$272.84
|
| Rate for Payer: MDX Hawaii PPO |
$348.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$272.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$272.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$272.84
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HEP C QUANT SO
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
3068752201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$305.15 |
| Max. Negotiated Rate |
$348.23 |
| Rate for Payer: Cash Price |
$215.40
|
| Rate for Payer: Health Management Network Commercial |
$305.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.10
|
| Rate for Payer: MDX Hawaii PPO |
$348.23
|
|
|
HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK TYPES
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
3068762402
|
|
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 IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK TYPES
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
3068762402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.68 |
| 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 |
$48.29
|
| 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 |
$50.70
|
| 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 |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$88.36
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - COVID ID POCT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763504
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - COVID ID POCT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763504
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$326.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$361.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$326.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.80
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.80
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 AMP PR ABBOTT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$326.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$361.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$326.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.80
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.80
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 AMP PR ABBOTT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 COVID19 AP PAN
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$326.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$361.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$326.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.80
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.80
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 COVID19 AP PAN
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 RT PCR SO DLS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 RT PCR SO DLS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$326.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$361.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$326.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$326.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$326.80
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$326.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$326.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$326.80
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
4504604001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,988.20 |
| Max. Negotiated Rate |
$4,551.24 |
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,222.80
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
4504604001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,743.44 |
| Rate for Payer: AlohaCare Medicaid |
$2,346.00
|
| Rate for Payer: AlohaCare Medicare |
$3,565.92
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Cash Price |
$2,815.20
|
| Rate for Payer: Devoted Health Medicare |
$3,941.28
|
| 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 |
$3,565.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,457.40
|
| Rate for Payer: Health Management Network Commercial |
$3,988.20
|
| Rate for Payer: Humana Medicare |
$3,565.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,222.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,565.92
|
| Rate for Payer: MDX Hawaii PPO |
$4,551.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,565.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,565.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,565.92
|
| Rate for Payer: University Health Alliance Commercial |
$6,743.44
|
|
|
HC IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.80
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
|
