|
HC IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: AlohaCare Medicaid |
$81.00
|
| Rate for Payer: AlohaCare Medicare |
$123.12
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Devoted Health Medicare |
$136.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.90
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$123.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.12
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.12
|
| Rate for Payer: University Health Alliance Commercial |
$118.08
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$240.55 |
| Max. Negotiated Rate |
$274.51 |
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$274.51 |
| Rate for Payer: AlohaCare Medicaid |
$141.50
|
| Rate for Payer: AlohaCare Medicare |
$215.08
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$237.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.85
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Humana Medicare |
$215.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.08
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.08
|
| Rate for Payer: University Health Alliance Commercial |
$206.28
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$82.08
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$90.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$82.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.08
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.08
|
| Rate for Payer: University Health Alliance Commercial |
$78.72
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: AlohaCare Medicaid |
$37.50
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.25
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$14.44
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$15.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$14.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.44
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.44
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
3028630401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125 - CA 125
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
3028630401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$133.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$147.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$133.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.00
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.00
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
3028630101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$133.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$147.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$133.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.00
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.00
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9 - CANCER ANTIGEN 19-9
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86301
|
| Hospital Charge Code |
3028630101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
HC IMMUNOFIXATION ELP SERUM
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
3028633401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$181.39 |
| Rate for Payer: AlohaCare Medicaid |
$93.50
|
| Rate for Payer: AlohaCare Medicare |
$142.12
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Devoted Health Medicare |
$157.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.34
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Humana Medicare |
$142.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.12
|
| Rate for Payer: MDX Hawaii PPO |
$181.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.12
|
| Rate for Payer: University Health Alliance Commercial |
$57.74
|
|
|
HC IMMUNOFIXATION ELP SERUM
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 86334
|
| Hospital Charge Code |
3028633401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$158.95 |
| Max. Negotiated Rate |
$181.39 |
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Health Management Network Commercial |
$158.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.30
|
| Rate for Payer: MDX Hawaii PPO |
$181.39
|
|
|
HC IMMUNOGL LT CHAIN FR SE SO
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
3018352102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.25 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
|
|
HC IMMUNOGL LT CHAIN FR SE SO
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
3018352102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$110.20
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$121.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$110.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.20
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.20
|
| Rate for Payer: University Health Alliance Commercial |
$105.69
|
|
|
HC IMMUNOGL LT CHAIN FR UR SO
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
3018352101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$110.20
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Devoted Health Medicare |
$121.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$110.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.20
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.20
|
| Rate for Payer: University Health Alliance Commercial |
$105.69
|
|
|
HC IMMUNOGL LT CHAIN FR UR SO
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
3018352101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.25 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
IP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
7615470001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,929.20 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,336.80
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
OP
|
$8,152.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
7615470001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$7,907.44 |
| Rate for Payer: AlohaCare Medicaid |
$4,076.00
|
| Rate for Payer: AlohaCare Medicare |
$6,195.52
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Cash Price |
$4,891.20
|
| Rate for Payer: Devoted Health Medicare |
$6,847.68
|
| 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 |
$6,195.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,744.40
|
| Rate for Payer: Health Management Network Commercial |
$6,929.20
|
| Rate for Payer: Humana Medicare |
$6,195.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,336.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6,195.52
|
| Rate for Payer: MDX Hawaii PPO |
$7,907.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6,195.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$6,195.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$6,195.52
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
HCPCS 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,207.90 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,396.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
HCPCS 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,660.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,887.00
|
| Rate for Payer: AlohaCare Medicare |
$2,868.24
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Devoted Health Medicare |
$3,170.16
|
| 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 |
$2,868.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,585.30
|
| Rate for Payer: Health Management Network Commercial |
$3,207.90
|
| Rate for Payer: Humana Medicare |
$2,868.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,396.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,868.24
|
| Rate for Payer: MDX Hawaii PPO |
$3,660.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,868.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,868.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,868.24
|
| Rate for Payer: University Health Alliance Commercial |
$2,750.87
|
|
|
HC INCISION AND DRAINAGE, BURSA, FOOT
|
Facility
|
OP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 28001
|
| Hospital Charge Code |
4502800101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: AlohaCare Medicaid |
$3,157.00
|
| Rate for Payer: AlohaCare Medicare |
$4,798.64
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Devoted Health Medicare |
$5,303.76
|
| 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 |
$4,798.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,998.30
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: Humana Medicare |
$4,798.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,682.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,798.64
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,798.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,798.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,798.64
|
| Rate for Payer: University Health Alliance Commercial |
$4,602.27
|
|
|
HC INCISION AND DRAINAGE, BURSA, FOOT
|
Facility
|
IP
|
$6,314.00
|
|
|
Service Code
|
HCPCS 28001
|
| Hospital Charge Code |
4502800101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,366.90 |
| Max. Negotiated Rate |
$6,124.58 |
| Rate for Payer: Cash Price |
$3,788.40
|
| Rate for Payer: Health Management Network Commercial |
$5,366.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,682.60
|
| Rate for Payer: MDX Hawaii PPO |
$6,124.58
|
|
