|
HC ESCHAROTOMY
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
7611603501
|
|
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 ESCHAROTOMY; EACH ADDITIONAL INCISION
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 16036
|
| Hospital Charge Code |
4501603601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.93 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$201.50
|
| Rate for Payer: AlohaCare Medicare |
$124.93
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Devoted Health Medicare |
$137.02
|
| 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 |
$124.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$382.85
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Humana Medicare |
$124.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.93
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.93
|
| Rate for Payer: University Health Alliance Commercial |
$293.75
|
|
|
HC ESCHAROTOMY; EACH ADDITIONAL INCISION
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 16036
|
| Hospital Charge Code |
4501603601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.55 |
| Max. Negotiated Rate |
$390.91 |
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
|
|
HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
7504346001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: AlohaCare Medicaid |
$1,826.50
|
| Rate for Payer: AlohaCare Medicare |
$1,132.43
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Devoted Health Medicare |
$1,242.02
|
| 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 |
$1,132.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,470.35
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Humana Medicare |
$1,132.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,132.43
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,132.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,132.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,132.43
|
| Rate for Payer: University Health Alliance Commercial |
$2,662.67
|
|
|
HC ESOPHAGOGASTRIC TAMPONADE,BALLOON - MINNESOTA TUBE INSERTION
|
Facility
|
IP
|
$3,653.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
7504346001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,105.05 |
| Max. Negotiated Rate |
$3,543.41 |
| Rate for Payer: Cash Price |
$2,191.80
|
| Rate for Payer: Health Management Network Commercial |
$3,105.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,287.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,543.41
|
|
|
HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$18.91
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Devoted Health Medicare |
$20.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$18.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.91
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.91
|
| Rate for Payer: University Health Alliance Commercial |
$18.48
|
|
|
HC EXAM,SYNOVIAL FLUID CRYSTALS - SYNOVIAL FLUID CRYSTAL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
3008906001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
HC EXPLO/DRAIN BREAST ABSCESS
|
Facility
|
IP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
7611902001
|
|
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 EXPLO/DRAIN BREAST ABSCESS
|
Facility
|
OP
|
$6,448.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
7611902001
|
|
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 |
$5,160.40
|
|
|
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
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 FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 88182
|
| Hospital Charge Code |
3118818201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.12 |
| 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 |
$68.89
|
| 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 |
$53.12
|
| 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 |
$68.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$160.58
|
| Rate for Payer: University Health Alliance Commercial |
$210.97
|
|
|
HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
|
Facility
|
OP
|
$1,389.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
3108124501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$1,347.33 |
| Rate for Payer: AlohaCare Medicaid |
$694.50
|
| Rate for Payer: AlohaCare Medicare |
$430.59
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Devoted Health Medicare |
$472.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$162.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$206.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$430.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$162.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.51
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: Humana Medicare |
$430.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,250.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$708.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$430.59
|
| Rate for Payer: MDX Hawaii PPO |
$1,347.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$430.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$430.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$430.59
|
| Rate for Payer: University Health Alliance Commercial |
$207.20
|
|
|
HC FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS
|
Facility
|
IP
|
$1,389.00
|
|
|
Service Code
|
HCPCS 81245
|
| Hospital Charge Code |
3108124501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,180.65 |
| Max. Negotiated Rate |
$1,347.33 |
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Health Management Network Commercial |
$1,180.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,250.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,347.33
|
|
|
HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
3068710701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
3068710701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$26.97
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Devoted Health Medicare |
$29.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$26.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.97
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.97
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
HC GLUCOSE BLOOD REAGENT STRIP
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3018294801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HC GLUCOSE BLOOD REAGENT STRIP
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
3018294801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$13.02
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$14.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.04
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$13.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.02
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.02
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
3018303601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: MDX Hawaii PPO |
$78.57
|
|
|
HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
3018303601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: AlohaCare Medicaid |
$40.50
|
| Rate for Payer: AlohaCare Medicare |
$25.11
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Devoted Health Medicare |
$27.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.71
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Humana Medicare |
$25.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.11
|
| Rate for Payer: MDX Hawaii PPO |
$78.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.11
|
| Rate for Payer: University Health Alliance Commercial |
$25.09
|
|
|
HC GONADOTROPIN (FSH) - FSH
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
3018300101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: AlohaCare Medicaid |
$78.00
|
| Rate for Payer: AlohaCare Medicare |
$48.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$53.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.58
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$48.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.36
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.36
|
| Rate for Payer: University Health Alliance Commercial |
$48.04
|
|
|
HC GONADOTROPIN (FSH) - FSH
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
3018300101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HC GONADOTROPIN (LH) - LUTEINIZING HORMONE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 83002
|
| Hospital Charge Code |
3018300201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
|
|
HC GONADOTROPIN (LH) - LUTEINIZING HORMONE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 83002
|
| Hospital Charge Code |
3018300201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: AlohaCare Medicaid |
$77.50
|
| Rate for Payer: AlohaCare Medicare |
$48.05
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Devoted Health Medicare |
$52.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.52
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Humana Medicare |
$48.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.05
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.05
|
| Rate for Payer: University Health Alliance Commercial |
$47.88
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
