|
HC SONO PELVIS LIMITED - US PELVIS LIMITED
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685703
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC SONO PELVIS LIMITED - US PELVIS LIMITED BLADDER
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
4027685701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$402.04
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$444.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$402.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$402.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$402.04
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$402.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$402.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
HC STOOL CULTURE, ADDL PATHOGENS - CULT STOOL ADD PATH EA
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
3068704601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: AlohaCare Medicaid |
$39.50
|
| Rate for Payer: AlohaCare Medicare |
$60.04
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Devoted Health Medicare |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$60.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Humana Medicare |
$60.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$60.04
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$60.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$60.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$60.04
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HC STOOL CULTURE, ADDL PATHOGENS - CULT STOOL ADD PATH EA
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
3068704601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
|
|
HC STRAP ELBOW/WRIST
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
4202926001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC STRAP ELBOW/WRIST
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
4202926001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$179.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$198.24
|
| 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 |
$179.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$179.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.36
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC STRAP HAND/FINGER
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
4202928001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$179.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$198.24
|
| 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 |
$179.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$179.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.36
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC STRAP HAND/FINGER
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
4202928001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC STRAP HIP
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
4202952001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC STRAP HIP
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
4202952001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$389.88
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$430.92
|
| 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 |
$389.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$389.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.88
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.88
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC STRAPPING; ANKLE &/OR FOOT
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
7612954001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: AlohaCare Medicaid |
$314.00
|
| Rate for Payer: AlohaCare Medicare |
$477.28
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$527.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$207.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$477.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$477.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$320.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.28
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$477.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$477.28
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC STRAPPING; ANKLE &/OR FOOT
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
7612954001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC STRAPPING; TOES
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
4502955001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$179.36
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$198.24
|
| 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 |
$179.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$179.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.36
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$179.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$179.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$179.36
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC STRAPPING; TOES
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
4502955001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
7002958001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$533.80 |
| Max. Negotiated Rate |
$609.16 |
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
7002958001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$314.00
|
| Rate for Payer: AlohaCare Medicare |
$477.28
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Devoted Health Medicare |
$527.52
|
| 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 |
$477.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$596.60
|
| Rate for Payer: Health Management Network Commercial |
$533.80
|
| Rate for Payer: Humana Medicare |
$477.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$565.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$477.28
|
| Rate for Payer: MDX Hawaii PPO |
$609.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$477.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$477.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$477.28
|
| Rate for Payer: University Health Alliance Commercial |
$457.75
|
|
|
HC STRAP SHOULDER
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
4202924001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$389.88
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$430.92
|
| 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 |
$389.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$389.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.88
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.88
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC STRAP SHOULDER
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
4202924001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
3068788001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$105.64
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Devoted Health Medicare |
$116.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$105.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.64
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.64
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
3068788001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$83.40
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
HC STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
3068765101
|
|
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 STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
3068765101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| 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 |
$29.42
|
| 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 |
$48.48
|
| 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 |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC SUSCEPTIBILITY PER AGENT
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
3068718101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
HC SUSCEPTIBILITY PER AGENT
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
3068718101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$33.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.40
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.40
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
