|
HC HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4809295001
|
|
Hospital Revenue Code
|
480
|
| 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 HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
4809295001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.25 |
| 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 |
$168.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$34.50
|
| Rate for Payer: AlohaCare Medicare |
$21.39
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Devoted Health Medicare |
$23.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$21.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.39
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.39
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
3018007601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$47.00
|
| Rate for Payer: AlohaCare Medicare |
$29.14
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Devoted Health Medicare |
$31.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.26
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$29.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.14
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.14
|
| Rate for Payer: University Health Alliance Commercial |
$29.10
|
|
|
HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY - HEPATITIS A ANTIBODY, IGM
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
3028670901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$27.90
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$30.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$27.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.90
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.90
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HC HEPATITIS B SURFACE AB TEST - HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
3028670601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$37.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Devoted Health Medicare |
$40.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.20
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.20
|
| Rate for Payer: University Health Alliance Commercial |
$36.89
|
|
|
HC HEPATITIS C AB TEST - HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
3028680301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: AlohaCare Medicaid |
$200.00
|
| Rate for Payer: AlohaCare Medicare |
$124.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Devoted Health Medicare |
$136.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$65.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.63
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Humana Medicare |
$124.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.00
|
| Rate for Payer: University Health Alliance Commercial |
$123.10
|
|
|
HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 80074
|
| Hospital Charge Code |
3018007401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
3028630801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$13.33
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$14.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$13.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.33
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.33
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
3028630801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC HIV 1/2 AG AB W/RFX W/BLOT
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
3068738902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$68.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.08
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$62.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.62
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.62
|
| Rate for Payer: University Health Alliance Commercial |
$63.12
|
|
|
HC HIV 1/2 AG AB W/RFX W/BLOT
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
3068738902
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
HC HIV-1 AG W/HIV 1/2 ABS
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
3068738903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
HC HIV-1 AG W/HIV 1/2 ABS
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
3068738903
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$68.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.08
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$62.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.62
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.62
|
| Rate for Payer: University Health Alliance Commercial |
$63.12
|
|
|
HC IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
3068734001
|
|
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 IAAD IA HEPATITIS B SURFACE ANTIGEN - HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
3068734001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| 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 |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.33
|
| 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 |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.97
|
| Rate for Payer: University Health Alliance Commercial |
$26.70
|
|
|
HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
3068742501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$31.31
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Devoted Health Medicare |
$34.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$31.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.31
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.31
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 87425
|
| Hospital Charge Code |
3068742501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK TYPES
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
3068762402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV HIGH RISK TYPES
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
3068762402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$91.14
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$99.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$91.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.14
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: University Health Alliance Commercial |
$88.36
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - COVID ID POCT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763504
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$365.50 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
|
