|
HAND REST ORHTOSIS LEFT SM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$83.08
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$91.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$83.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.08
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.08
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS LEFT SM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT REG
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT REG
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$83.08
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$91.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$83.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.08
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.08
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT SM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HAND REST ORHTOSIS RIGHT SM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS L3809
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$83.08
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$91.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$83.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.08
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.08
|
| Rate for Payer: University Health Alliance Commercial |
$150.08
|
|
|
HARMONIC ACE 8MM IS4000 480275
|
Facility
|
IP
|
$1,717.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,459.45 |
| Max. Negotiated Rate |
$1,665.49 |
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Health Management Network Commercial |
$1,459.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,545.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,665.49
|
|
|
HARMONIC ACE 8MM IS4000 480275
|
Facility
|
OP
|
$1,717.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.27 |
| Max. Negotiated Rate |
$1,665.49 |
| Rate for Payer: AlohaCare Medicaid |
$858.50
|
| Rate for Payer: AlohaCare Medicare |
$532.27
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Devoted Health Medicare |
$583.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$532.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,631.15
|
| Rate for Payer: Health Management Network Commercial |
$1,459.45
|
| Rate for Payer: Humana Medicare |
$532.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,545.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$875.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$532.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,665.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$532.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$532.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$532.27
|
| Rate for Payer: University Health Alliance Commercial |
$1,251.52
|
|
|
HARVESTER QUADPRO AR-2386-10
|
Facility
|
OP
|
$1,562.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.22 |
| Max. Negotiated Rate |
$1,515.14 |
| Rate for Payer: AlohaCare Medicaid |
$781.00
|
| Rate for Payer: AlohaCare Medicare |
$484.22
|
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Devoted Health Medicare |
$531.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$484.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,483.90
|
| Rate for Payer: Health Management Network Commercial |
$1,327.70
|
| Rate for Payer: Humana Medicare |
$484.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,405.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$796.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.22
|
| Rate for Payer: MDX Hawaii PPO |
$1,515.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$484.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$484.22
|
| Rate for Payer: University Health Alliance Commercial |
$1,138.54
|
|
|
HARVESTER QUADPRO AR-2386-10
|
Facility
|
IP
|
$1,562.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,327.70 |
| Max. Negotiated Rate |
$1,515.14 |
| Rate for Payer: Cash Price |
$937.20
|
| Rate for Payer: Health Management Network Commercial |
$1,327.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,405.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,515.14
|
|
|
HB OBSERVATION CARVE-OUT - CARDIOLOGY
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037804
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
|
|
HB OBSERVATION CARVE-OUT - CARDIOLOGY
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037804
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: AlohaCare Medicaid |
$87.00
|
| Rate for Payer: AlohaCare Medicare |
$53.94
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$59.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,200.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.30
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Humana Medicare |
$53.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.94
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.94
|
| Rate for Payer: University Health Alliance Commercial |
$126.83
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
3507637601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$553.87 |
| Rate for Payer: AlohaCare Medicaid |
$285.50
|
| Rate for Payer: AlohaCare Medicare |
$177.01
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Devoted Health Medicare |
$194.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$98.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.45
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Humana Medicare |
$177.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.01
|
| Rate for Payer: MDX Hawaii PPO |
$553.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.01
|
| Rate for Payer: University Health Alliance Commercial |
$214.08
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
4027637601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$692.58 |
| Rate for Payer: AlohaCare Medicaid |
$357.00
|
| Rate for Payer: AlohaCare Medicare |
$221.34
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Devoted Health Medicare |
$242.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$98.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$678.30
|
| Rate for Payer: Health Management Network Commercial |
$606.90
|
| Rate for Payer: Humana Medicare |
$221.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$364.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.34
|
| Rate for Payer: MDX Hawaii PPO |
$692.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.34
|
| Rate for Payer: University Health Alliance Commercial |
$214.08
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
4027637601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$606.90 |
| Max. Negotiated Rate |
$692.58 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Health Management Network Commercial |
$606.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$642.60
|
| Rate for Payer: MDX Hawaii PPO |
$692.58
|
|
|
HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
3507637601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.35 |
| Max. Negotiated Rate |
$553.87 |
| Rate for Payer: Cash Price |
$342.60
|
| Rate for Payer: Health Management Network Commercial |
$485.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.90
|
| Rate for Payer: MDX Hawaii PPO |
$553.87
|
|
|
HC ADMIN INFLUENZA VIRUS VAC
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
771G000801
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
HC ADMIN INFLUENZA VIRUS VAC
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
771G000801
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$57.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$62.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.80
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$57.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.04
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.04
|
| Rate for Payer: University Health Alliance Commercial |
$134.12
|
|
|
HC AGENT NOS ASSAY W/OPTIC - CAMPY ANTIGEN DIRECT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$41.85
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$45.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$41.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.85
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.85
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC AGENT NOS ASSAY W/OPTIC - CAMPY ANTIGEN DIRECT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 1
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$41.85
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$45.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$41.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.85
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.85
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 1
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 2
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HC AGENT NOS ASSAY W/OPTIC - SHIGA TOXIN 2
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
3068789903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$41.85
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Devoted Health Medicare |
$45.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$41.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.85
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.85
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 46600
|
| Hospital Charge Code |
7614660001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.03 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$256.50
|
| Rate for Payer: AlohaCare Medicare |
$159.03
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$174.42
|
| 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 |
$159.03
|
| 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 |
$159.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$461.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.03
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.03
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
