|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - COVID ID POCT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763504
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$133.30
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$146.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$133.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.30
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.30
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 AMP PR ABBOTT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$133.30
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$146.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$133.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.30
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.30
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV-2 AMP PR ABBOTT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763503
|
|
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
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 COVID19 AP PAN
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763502
|
|
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
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 COVID19 AP PAN
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763502
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$133.30
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$146.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$133.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.30
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.30
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 RT PCR SO DLS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763501
|
|
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
|
|
|
HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ - SARS-COV2 RT PCR SO DLS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
3068763501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.00
|
| Rate for Payer: AlohaCare Medicare |
$133.30
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Devoted Health Medicare |
$146.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$365.50
|
| Rate for Payer: Humana Medicare |
$133.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.30
|
| Rate for Payer: MDX Hawaii PPO |
$417.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.30
|
| Rate for Payer: University Health Alliance Commercial |
$94.96
|
|
|
HC I&D OF VULVA/PERINEUM ABSCESS
|
Facility
|
IP
|
$1,211.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
7615640501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,029.35 |
| Max. Negotiated Rate |
$1,174.67 |
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Health Management Network Commercial |
$1,029.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,089.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,174.67
|
|
|
HC I&D OF VULVA/PERINEUM ABSCESS
|
Facility
|
OP
|
$1,211.00
|
|
|
Service Code
|
HCPCS 56405
|
| Hospital Charge Code |
7615640501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.23 |
| Max. Negotiated Rate |
$1,174.67 |
| Rate for Payer: AlohaCare Medicaid |
$605.50
|
| Rate for Payer: AlohaCare Medicare |
$375.41
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Devoted Health Medicare |
$411.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$389.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$375.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,150.45
|
| Rate for Payer: Health Management Network Commercial |
$1,029.35
|
| Rate for Payer: Humana Medicare |
$375.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,089.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$617.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$375.41
|
| Rate for Payer: MDX Hawaii PPO |
$1,174.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$375.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$375.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$375.41
|
| Rate for Payer: University Health Alliance Commercial |
$882.70
|
|
|
HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE - IMMUNOHISTOCHEM EA ADD
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834102
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: AlohaCare Medicaid |
$222.50
|
| Rate for Payer: AlohaCare Medicare |
$137.95
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Devoted Health Medicare |
$151.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$422.75
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Humana Medicare |
$137.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$226.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.95
|
| Rate for Payer: MDX Hawaii PPO |
$431.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.95
|
| Rate for Payer: University Health Alliance Commercial |
$139.55
|
|
|
HC IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE - IMMUNOHISTOCHEM EA ADD
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 88341
|
| Hospital Charge Code |
3128834102
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$378.25 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.50
|
| Rate for Payer: MDX Hawaii PPO |
$431.65
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - BUNDLED CHARGE
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3108834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: AlohaCare Medicaid |
$849.00
|
| Rate for Payer: AlohaCare Medicare |
$526.38
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Devoted Health Medicare |
$577.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$526.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: Humana Medicare |
$526.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,528.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$865.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$526.38
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$526.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$526.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$526.38
|
| Rate for Payer: University Health Alliance Commercial |
$193.25
|
|
|
HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - BUNDLED CHARGE
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88342
|
| Hospital Charge Code |
3108834201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,443.30 |
| Max. Negotiated Rate |
$1,647.06 |
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Health Management Network Commercial |
$1,443.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,528.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,647.06
|
|
|
HC IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: AlohaCare Medicaid |
$81.00
|
| Rate for Payer: AlohaCare Medicare |
$50.22
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Devoted Health Medicare |
$55.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$153.90
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$50.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.22
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.22
|
| Rate for Payer: University Health Alliance Commercial |
$118.08
|
|
|
HC IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 90480
|
| Hospital Charge Code |
7719048001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.80
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$240.55 |
| Max. Negotiated Rate |
$274.51 |
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
|
|
HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
7719047101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$274.51 |
| Rate for Payer: AlohaCare Medicaid |
$141.50
|
| Rate for Payer: AlohaCare Medicare |
$87.73
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Devoted Health Medicare |
$96.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$91.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$268.85
|
| Rate for Payer: Health Management Network Commercial |
$240.55
|
| Rate for Payer: Humana Medicare |
$87.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$144.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.73
|
| Rate for Payer: MDX Hawaii PPO |
$274.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.73
|
| Rate for Payer: University Health Alliance Commercial |
$206.28
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC IMMUNIZ,ADMIN,EACH ADDL
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 90472
|
| Hospital Charge Code |
7719047201
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$36.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$33.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.48
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.48
|
| Rate for Payer: University Health Alliance Commercial |
$78.72
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: AlohaCare Medicaid |
$37.50
|
| Rate for Payer: AlohaCare Medicare |
$23.25
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Devoted Health Medicare |
$25.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.25
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Humana Medicare |
$23.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.25
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.25
|
| Rate for Payer: University Health Alliance Commercial |
$54.67
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
7719046001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$5.89
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$6.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$5.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.89
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.89
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
HC IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
7719046101
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
HC IMMUNOHISTOCHEM EA MULT
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,029.40 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,207.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
|
|
HC IMMUNOHISTOCHEM EA MULT
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: AlohaCare Medicaid |
$1,782.00
|
| Rate for Payer: AlohaCare Medicare |
$1,104.84
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Devoted Health Medicare |
$1,211.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,104.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Humana Medicare |
$1,104.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,207.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,817.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,104.84
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,104.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,104.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,104.84
|
| Rate for Payer: University Health Alliance Commercial |
$242.83
|
|
