|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$15.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$14.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.57
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.57
|
| Rate for Payer: University Health Alliance Commercial |
$14.24
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
HC BRONCHOSCOPY,REMV FOR. BODY
|
Facility
|
OP
|
$6,720.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
7613163501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,518.40 |
| Rate for Payer: AlohaCare Medicaid |
$3,360.00
|
| Rate for Payer: AlohaCare Medicare |
$2,083.20
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Devoted Health Medicare |
$2,284.80
|
| 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 |
$2,083.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,384.00
|
| Rate for Payer: Health Management Network Commercial |
$5,712.00
|
| Rate for Payer: Humana Medicare |
$2,083.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,048.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,083.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,518.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,083.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,083.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,083.20
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC BRONCHOSCOPY,REMV FOR. BODY
|
Facility
|
IP
|
$6,720.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
7613163501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,712.00 |
| Max. Negotiated Rate |
$6,518.40 |
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Health Management Network Commercial |
$5,712.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,048.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,518.40
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| 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 CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$36.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.90
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$33.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.48
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.48
|
| Rate for Payer: University Health Alliance Commercial |
$21.40
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION MULT
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION MULT
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$480.19
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$526.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$480.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.19
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$480.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION SING
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION SING
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$480.19
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$526.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$480.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.19
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$480.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301712
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301712
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$480.19
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$526.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$480.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.19
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$480.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301711
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$480.19
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$526.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$480.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.19
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$480.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301711
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING ONLY
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING ONLY
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301701
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$480.19
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$526.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$480.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.19
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$480.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
9189616101
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$36.89
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$40.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.05
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Humana Medicare |
$36.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.89
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
|
|
HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
9189616101
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HC CAREGIVER TRAING 1ST 30 MIN
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 97550 GP
|
| Hospital Charge Code |
9429755001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$46.47 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$73.78
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Devoted Health Medicare |
$80.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$226.10
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$73.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.78
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.78
|
| Rate for Payer: University Health Alliance Commercial |
$173.48
|
|
|
HC CAREGIVER TRAING 1ST 30 MIN
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 97550 GP
|
| Hospital Charge Code |
9429755001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HC CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
4503651001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.15 |
| Max. Negotiated Rate |
$290.03 |
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.10
|
| Rate for Payer: MDX Hawaii PPO |
$290.03
|
|
|
HC CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
4503651001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.69 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$149.50
|
| Rate for Payer: AlohaCare Medicare |
$92.69
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Devoted Health Medicare |
$101.66
|
| 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 |
$92.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$284.05
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Humana Medicare |
$92.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.69
|
| Rate for Payer: MDX Hawaii PPO |
$290.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.69
|
| Rate for Payer: University Health Alliance Commercial |
$217.94
|
|
|
HC CATH RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP
|
Facility
|
OP
|
$16,000.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
4819345301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$15,520.00 |
| Rate for Payer: AlohaCare Medicaid |
$8,000.00
|
| Rate for Payer: AlohaCare Medicare |
$4,960.00
|
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Devoted Health Medicare |
$5,440.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4,140.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,960.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15,200.00
|
| Rate for Payer: Health Management Network Commercial |
$13,600.00
|
| Rate for Payer: Humana Medicare |
$4,960.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,400.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8,160.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,960.00
|
| Rate for Payer: MDX Hawaii PPO |
$15,520.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,960.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,960.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,960.00
|
| Rate for Payer: University Health Alliance Commercial |
$11,662.40
|
|
|
HC CATH RIGHT & LEFT HEART CATH INJECT VETRICULOGRAPHY, IMAGE SUPERVISE/INTERP
|
Facility
|
IP
|
$16,000.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
4819345301
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,600.00 |
| Max. Negotiated Rate |
$15,520.00 |
| Rate for Payer: Cash Price |
$9,600.00
|
| Rate for Payer: Health Management Network Commercial |
$13,600.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14,400.00
|
| Rate for Payer: MDX Hawaii PPO |
$15,520.00
|
|
|
HC C DIFF AMP PROBE/CDT
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
3068749302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$303.61 |
| Rate for Payer: AlohaCare Medicaid |
$156.50
|
| Rate for Payer: AlohaCare Medicare |
$97.03
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$106.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.27
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Humana Medicare |
$97.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$281.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.03
|
| Rate for Payer: MDX Hawaii PPO |
$303.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.03
|
| Rate for Payer: University Health Alliance Commercial |
$93.00
|
|
