|
HC TTE W/DOPPLER COMPLETE - TTE COMPLETE
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
4839330602
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$3,340.50 |
| Max. Negotiated Rate |
$3,812.10 |
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Health Management Network Commercial |
$3,340.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,537.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,812.10
|
|
|
HC UA MICRO ONLY
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$19.76
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$21.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Humana Medicare |
$19.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.76
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.76
|
| Rate for Payer: University Health Alliance Commercial |
$7.84
|
|
|
HC UA MICRO ONLY
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
|
|
HC UA MICRO REFLEX CULT
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101502
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
|
|
HC UA MICRO REFLEX CULT
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101502
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$19.76
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$21.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Humana Medicare |
$19.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.76
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.76
|
| Rate for Payer: University Health Alliance Commercial |
$7.84
|
|
|
HC UMBILICAL ARTERY CATHETERIZATION FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
4503666001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.90 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.60
|
| Rate for Payer: MDX Hawaii PPO |
$246.38
|
|
|
HC UMBILICAL ARTERY CATHETERIZATION FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
4503666001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$127.00
|
| Rate for Payer: AlohaCare Medicare |
$193.04
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Devoted Health Medicare |
$213.36
|
| 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 |
$193.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.30
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Humana Medicare |
$193.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.04
|
| Rate for Payer: MDX Hawaii PPO |
$246.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$193.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.04
|
| Rate for Payer: University Health Alliance Commercial |
$185.14
|
|
|
HC UNDER OTHER EMERGENCY SERVICES
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 99288
|
| Hospital Charge Code |
4509928801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$138.50
|
| Rate for Payer: AlohaCare Medicare |
$210.52
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Devoted Health Medicare |
$232.68
|
| 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 |
$210.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$263.15
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Humana Medicare |
$210.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$210.52
|
| Rate for Payer: MDX Hawaii PPO |
$268.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$210.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$210.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$210.52
|
| Rate for Payer: University Health Alliance Commercial |
$201.91
|
|
|
HC UNDER OTHER EMERGENCY SERVICES
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 99288
|
| Hospital Charge Code |
4509928801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.45 |
| Max. Negotiated Rate |
$268.69 |
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.30
|
| Rate for Payer: MDX Hawaii PPO |
$268.69
|
|
|
HC UNLISTED DX RADIOGRAPHIC PROCEDURE
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
3207649901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$332.88
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$367.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$332.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.88
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.88
|
| Rate for Payer: University Health Alliance Commercial |
$319.26
|
|
|
HC UNLISTED DX RADIOGRAPHIC PROCEDURE
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
3207649901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC UNLISTED PROCEDURE, RECTUM
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
4504599901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,519.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,814.00
|
| Rate for Payer: AlohaCare Medicare |
$2,757.28
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Devoted Health Medicare |
$3,047.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,757.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,446.60
|
| Rate for Payer: Health Management Network Commercial |
$3,083.80
|
| Rate for Payer: Humana Medicare |
$2,757.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,265.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,757.28
|
| Rate for Payer: MDX Hawaii PPO |
$3,519.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,757.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,757.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,757.28
|
| Rate for Payer: University Health Alliance Commercial |
$2,644.45
|
|
|
HC UNLISTED PROCEDURE, RECTUM
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
4504599901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,083.80 |
| Max. Negotiated Rate |
$3,519.16 |
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Health Management Network Commercial |
$3,083.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,265.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,519.16
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100301
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| 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 |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.44
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100301
|
|
Hospital Revenue Code
|
307
|
| 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 URINALYSIS, AUTO, W/SCOPE - UA REFLEX C&S
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100102
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: AlohaCare Medicaid |
$13.50
|
| Rate for Payer: AlohaCare Medicare |
$20.52
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Humana Medicare |
$20.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.52
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.52
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - UA REFLEX C&S
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100102
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: AlohaCare Medicaid |
$13.50
|
| Rate for Payer: AlohaCare Medicare |
$20.52
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Humana Medicare |
$20.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.52
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.52
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: AlohaCare Medicaid |
$14.50
|
| Rate for Payer: AlohaCare Medicare |
$22.04
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Devoted Health Medicare |
$24.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Humana Medicare |
$22.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.04
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.04
|
| Rate for Payer: University Health Alliance Commercial |
$6.60
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$54.72
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$60.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.61
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$54.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.72
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.72
|
| Rate for Payer: University Health Alliance Commercial |
$16.35
|
|
|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670506
|
|
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 US, ABDOMEN LIMITED - US ABDOMEN LIMITED
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| 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 |
$46.98
|
| 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 |
$50.90
|
| 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 |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$402.04
|
| Rate for Payer: University Health Alliance Commercial |
$200.93
|
|
