|
HC DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
4504180001
|
|
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
|
|
|
HC DRAINAGE OF NASAL ABSCESS
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
4503000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.44 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$462.00
|
| Rate for Payer: AlohaCare Medicare |
$286.44
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Devoted Health Medicare |
$314.16
|
| 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 |
$286.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$877.80
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Humana Medicare |
$286.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.44
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.44
|
| Rate for Payer: University Health Alliance Commercial |
$673.50
|
|
|
HC DRAINAGE OF NASAL ABSCESS
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
4503000001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$785.40 |
| Max. Negotiated Rate |
$896.28 |
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Management Network Commercial |
$785.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$831.60
|
| Rate for Payer: MDX Hawaii PPO |
$896.28
|
|
|
HC DRAINAGE OF NASAL SEPTAL ABSCESS
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 30020
|
| Hospital Charge Code |
4503002001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,966.19 |
| Rate for Payer: AlohaCare Medicaid |
$1,013.50
|
| Rate for Payer: AlohaCare Medicare |
$628.37
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Devoted Health Medicare |
$689.18
|
| 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 |
$628.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,925.65
|
| Rate for Payer: Health Management Network Commercial |
$1,722.95
|
| Rate for Payer: Humana Medicare |
$628.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,824.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$628.37
|
| Rate for Payer: MDX Hawaii PPO |
$1,966.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$628.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$628.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$628.37
|
| Rate for Payer: University Health Alliance Commercial |
$1,477.48
|
|
|
HC DRAINAGE OF NASAL SEPTAL ABSCESS
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
HCPCS 30020
|
| Hospital Charge Code |
4503002001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,722.95 |
| Max. Negotiated Rate |
$1,966.19 |
| Rate for Payer: Cash Price |
$1,216.20
|
| Rate for Payer: Health Management Network Commercial |
$1,722.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,824.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,966.19
|
|
|
HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
7616900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 69005
|
| Hospital Charge Code |
7616900501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$3,224.00
|
| Rate for Payer: AlohaCare Medicare |
$1,998.88
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$2,192.32
|
| 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 |
$1,998.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,125.60
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$1,998.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,998.88
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,998.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,998.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,998.88
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRAIN FINGER ABSCESS,COMPLICATED
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
7612601101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: AlohaCare Medicaid |
$3,224.00
|
| Rate for Payer: AlohaCare Medicare |
$1,998.88
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Devoted Health Medicare |
$2,192.32
|
| 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 |
$1,998.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,125.60
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Humana Medicare |
$1,998.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,998.88
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,998.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,998.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,998.88
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRAIN FINGER ABSCESS,COMPLICATED
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 26011
|
| Hospital Charge Code |
7612601101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,480.80 |
| Max. Negotiated Rate |
$6,254.56 |
| Rate for Payer: Cash Price |
$3,868.80
|
| Rate for Payer: Health Management Network Commercial |
$5,480.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,803.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,254.56
|
|
|
HC DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4501006001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4501006001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$245.21
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$268.94
|
| 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 |
$245.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$245.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.21
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.21
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRESS/DEBRID LARGE BURN NO ANESTH
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
7611603001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 |
$1,158.95
|
|
|
HC DRESS/DEBRID LARGE BURN NO ANESTH
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
7611603001
|
|
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
|
|
|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
7611602501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
7611602501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$245.21
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$268.94
|
| 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 |
$245.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$245.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.21
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.21
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
3018016401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
3018016401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$35.34
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$38.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.54
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$35.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.34
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.34
|
| Rate for Payer: University Health Alliance Commercial |
$35.02
|
|
|
HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
3018016201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
3018016201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$34.41
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$37.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.28
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$34.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.41
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.41
|
| Rate for Payer: University Health Alliance Commercial |
$34.32
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: AlohaCare Medicaid |
$260.50
|
| Rate for Payer: AlohaCare Medicare |
$161.51
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Devoted Health Medicare |
$177.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.51
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Humana Medicare |
$161.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$265.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.51
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.51
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$442.85 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
|
|
HC DRUG TEST PRSMV DIR OPT OBS
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
3018030501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: AlohaCare Medicaid |
$53.00
|
| Rate for Payer: AlohaCare Medicare |
$32.86
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Devoted Health Medicare |
$36.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Humana Medicare |
$32.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.86
|
| Rate for Payer: MDX Hawaii PPO |
$102.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.86
|
| Rate for Payer: University Health Alliance Commercial |
$27.68
|
|
|
HC DRUG TEST PRSMV DIR OPT OBS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
3018030501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.40
|
| Rate for Payer: MDX Hawaii PPO |
$102.82
|
|
|
HC ECHO CONTRAST AGENT USED
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 93352
|
| Hospital Charge Code |
4839335201
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$693.55 |
| Rate for Payer: AlohaCare Medicaid |
$357.50
|
| Rate for Payer: AlohaCare Medicare |
$221.65
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Devoted Health Medicare |
$243.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$221.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$679.25
|
| Rate for Payer: Health Management Network Commercial |
$607.75
|
| Rate for Payer: Humana Medicare |
$221.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$643.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$364.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.65
|
| Rate for Payer: MDX Hawaii PPO |
$693.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$221.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$221.65
|
| Rate for Payer: University Health Alliance Commercial |
$521.16
|
|
|
HC ECHO CONTRAST AGENT USED
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 93352
|
| Hospital Charge Code |
4839335201
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$607.75 |
| Max. Negotiated Rate |
$693.55 |
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Health Management Network Commercial |
$607.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$643.50
|
| Rate for Payer: MDX Hawaii PPO |
$693.55
|
|
