|
HC CULT URINE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
3068708601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$23.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.07
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$21.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.08
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.87
|
|
|
HC CULT URINE ID
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
3068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HC CULT URINE ID
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
3068708801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$23.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.09
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$21.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.08
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
HC CULT VIRAL SO
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3068725202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$109.50
|
| Rate for Payer: AlohaCare Medicare |
$67.89
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$74.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$67.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.89
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.89
|
| Rate for Payer: University Health Alliance Commercial |
$67.38
|
|
|
HC CULT VIRAL SO
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
3068725202
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HC CULT WOUND
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
3068707003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$22.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$24.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$22.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.32
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.32
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HC CULT WOUND
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
3068707003
|
|
Hospital Revenue Code
|
306
|
| 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 CYTOPATH CONCENTRATE TECH - LAB CYTOPATH FLUIDS,CONCENTRATN,INTERP
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 88108 TC
|
| Hospital Charge Code |
3118810801
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
|
HC CYTOPATH CONCENTRATE TECH - LAB CYTOPATH FLUIDS,CONCENTRATN,INTERP
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 88108 TC
|
| Hospital Charge Code |
3118810801
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: AlohaCare Medicaid |
$194.50
|
| Rate for Payer: AlohaCare Medicare |
$120.59
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Devoted Health Medicare |
$132.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$369.55
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$120.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.59
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.59
|
| Rate for Payer: University Health Alliance Commercial |
$92.35
|
|
|
HC CYTOPATH EVAL FNA REPORT - LAB INTERPRETATION OF FNA SMEAR
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
3118817301
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$502.55
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$87.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$135.62
|
|
|
HC CYTOPATH EVAL FNA REPORT - LAB INTERPRETATION OF FNA SMEAR
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
3118817301
|
|
Hospital Revenue Code
|
311
|
| 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 CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$75.33
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$82.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.85
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$75.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.33
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.33
|
| Rate for Payer: University Health Alliance Commercial |
$57.11
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP TZANK
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$75.33
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Devoted Health Medicare |
$82.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$33.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$230.85
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$75.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.33
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.33
|
| Rate for Payer: University Health Alliance Commercial |
$57.11
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP TZANK
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
3118816002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP CONVENTIONAL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$47.43
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$52.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.54
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$47.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.43
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.43
|
| Rate for Payer: University Health Alliance Commercial |
$27.31
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP CONVENTIONAL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816401
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP DIAGNOSTIC MEDICARE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816402
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
HC CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV - PAP DIAGNOSTIC MEDICARE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
3118816402
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$47.43
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Devoted Health Medicare |
$52.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.54
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$47.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.43
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.43
|
| Rate for Payer: University Health Alliance Commercial |
$27.31
|
|
|
HC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88162
|
| Hospital Charge Code |
3118816201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: AlohaCare Medicaid |
$259.00
|
| Rate for Payer: AlohaCare Medicare |
$160.58
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Devoted Health Medicare |
$176.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$160.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Humana Medicare |
$160.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$264.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.58
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$160.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$160.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.58
|
| Rate for Payer: University Health Alliance Commercial |
$153.96
|
|
|
HC CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88162
|
| Hospital Charge Code |
3118816201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$502.46 |
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Health Management Network Commercial |
$440.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$466.20
|
| Rate for Payer: MDX Hawaii PPO |
$502.46
|
|
|
HC CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| 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 CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 88161
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.01 |
| 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 ABD |
$35.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.55
|
| 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 |
$35.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.78
|
| Rate for Payer: University Health Alliance Commercial |
$113.20
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
4501104201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$492.90
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$540.60
|
| 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 |
$492.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$492.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$492.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$492.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$492.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
4501104201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
