|
HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 83704
|
| Hospital Charge Code |
3018370401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$278.39 |
| Rate for Payer: AlohaCare Medicaid |
$143.50
|
| Rate for Payer: AlohaCare Medicare |
$88.97
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Devoted Health Medicare |
$97.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.19
|
| Rate for Payer: Health Management Network Commercial |
$243.95
|
| Rate for Payer: Humana Medicare |
$88.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.97
|
| Rate for Payer: MDX Hawaii PPO |
$278.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.97
|
| Rate for Payer: University Health Alliance Commercial |
$81.55
|
|
|
HC MEAS,POST-VOID RES,US,NON-IMAGING
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
7615179801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
HC MEAS,POST-VOID RES,US,NON-IMAGING
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
7615179801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$73.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Devoted Health Medicare |
$80.24
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$224.20
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$73.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.16
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE - BUNDLED CHARGE
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$27.59
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$30.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.56
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$27.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.59
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.59
|
| Rate for Payer: University Health Alliance Commercial |
$27.32
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE - POCT
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$27.59
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Devoted Health Medicare |
$30.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.56
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$27.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.59
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.59
|
| Rate for Payer: University Health Alliance Commercial |
$27.32
|
|
|
HC METABOLIC PANEL,COMPREHENSIVE - POCT
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
3018005302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS 80204
|
| Hospital Charge Code |
3018020401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$314.28 |
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Health Management Network Commercial |
$275.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$291.60
|
| Rate for Payer: MDX Hawaii PPO |
$314.28
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 80204
|
| Hospital Charge Code |
3018020401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$314.28 |
| Rate for Payer: AlohaCare Medicaid |
$162.00
|
| Rate for Payer: AlohaCare Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Devoted Health Medicare |
$110.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.57
|
| Rate for Payer: Health Management Network Commercial |
$275.40
|
| Rate for Payer: Humana Medicare |
$100.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$291.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$165.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.44
|
| Rate for Payer: MDX Hawaii PPO |
$314.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.44
|
| Rate for Payer: University Health Alliance Commercial |
$236.16
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$14.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Devoted Health Medicare |
$16.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.78
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Humana Medicare |
$14.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.88
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.88
|
| Rate for Payer: University Health Alliance Commercial |
$14.97
|
|
|
HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
3018204302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
|
|
HC MICROBIOTA FECAL PREP
|
Facility
|
OP
|
$3,390.00
|
|
|
Service Code
|
HCPCS G0455
|
| Hospital Charge Code |
750G045501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$3,288.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,695.00
|
| Rate for Payer: AlohaCare Medicare |
$1,050.90
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Devoted Health Medicare |
$1,152.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,187.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,050.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,220.50
|
| Rate for Payer: Health Management Network Commercial |
$2,881.50
|
| Rate for Payer: Humana Medicare |
$1,050.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,051.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,728.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,050.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,288.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,050.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,050.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,050.90
|
| Rate for Payer: University Health Alliance Commercial |
$2,470.97
|
|
|
HC MICROBIOTA FECAL PREP
|
Facility
|
IP
|
$3,390.00
|
|
|
Service Code
|
HCPCS G0455
|
| Hospital Charge Code |
750G045501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,881.50 |
| Max. Negotiated Rate |
$3,288.30 |
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Health Management Network Commercial |
$2,881.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,051.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,288.30
|
|
|
HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
3709915701
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$153.26 |
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.20
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
|
|
HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
3709915701
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$48.98 |
| Max. Negotiated Rate |
$153.26 |
| Rate for Payer: AlohaCare Medicaid |
$79.00
|
| Rate for Payer: AlohaCare Medicare |
$48.98
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Devoted Health Medicare |
$53.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.10
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Humana Medicare |
$48.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.98
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.98
|
| Rate for Payer: University Health Alliance Commercial |
$115.17
|
|
|
HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 99155
|
| Hospital Charge Code |
3709915501
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Management Network Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.20
|
| Rate for Payer: MDX Hawaii PPO |
$279.36
|
|
|
HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 99155
|
| Hospital Charge Code |
3709915501
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$59.68 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: AlohaCare Medicaid |
$144.00
|
| Rate for Payer: AlohaCare Medicare |
$89.28
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Devoted Health Medicare |
$97.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$273.60
|
| Rate for Payer: Health Management Network Commercial |
$244.80
|
| Rate for Payer: Humana Medicare |
$89.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.28
|
| Rate for Payer: MDX Hawaii PPO |
$279.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.28
|
| Rate for Payer: University Health Alliance Commercial |
$209.92
|
|
|
HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
3709915601
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$237.15 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$251.10
|
| Rate for Payer: MDX Hawaii PPO |
$270.63
|
|
|
HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
3709915601
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$53.37 |
| Max. Negotiated Rate |
$270.63 |
| Rate for Payer: AlohaCare Medicaid |
$139.50
|
| Rate for Payer: AlohaCare Medicare |
$86.49
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Devoted Health Medicare |
$94.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$265.05
|
| Rate for Payer: Health Management Network Commercial |
$237.15
|
| Rate for Payer: Humana Medicare |
$86.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$251.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$142.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.49
|
| Rate for Payer: MDX Hawaii PPO |
$270.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.49
|
| Rate for Payer: University Health Alliance Commercial |
$203.36
|
|
|
HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
3709915301
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$80.51 |
| Rate for Payer: AlohaCare Medicaid |
$41.50
|
| Rate for Payer: AlohaCare Medicare |
$25.73
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Devoted Health Medicare |
$28.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.85
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Humana Medicare |
$25.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.73
|
| Rate for Payer: MDX Hawaii PPO |
$80.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.73
|
| Rate for Payer: University Health Alliance Commercial |
$60.50
|
|
|
HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
3709915301
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$80.51 |
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.70
|
| Rate for Payer: MDX Hawaii PPO |
$80.51
|
|
|
HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 99151
|
| Hospital Charge Code |
3719915101
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: AlohaCare Medicaid |
$255.00
|
| Rate for Payer: AlohaCare Medicare |
$158.10
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Devoted Health Medicare |
$173.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$484.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Humana Medicare |
$158.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.10
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.10
|
| Rate for Payer: University Health Alliance Commercial |
$371.74
|
|
|
HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 99151
|
| Hospital Charge Code |
3719915101
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$433.50 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
|
|
HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 99152
|
| Hospital Charge Code |
3719915201
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$220.15 |
| Max. Negotiated Rate |
$251.23 |
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Health Management Network Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.10
|
| Rate for Payer: MDX Hawaii PPO |
$251.23
|
|
|
HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 99152
|
| Hospital Charge Code |
3719915201
|
|
Hospital Revenue Code
|
371
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$251.23 |
| Rate for Payer: AlohaCare Medicaid |
$129.50
|
| Rate for Payer: AlohaCare Medicare |
$80.29
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Devoted Health Medicare |
$88.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$246.05
|
| Rate for Payer: Health Management Network Commercial |
$220.15
|
| Rate for Payer: Humana Medicare |
$80.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.29
|
| Rate for Payer: MDX Hawaii PPO |
$251.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.29
|
| Rate for Payer: University Health Alliance Commercial |
$188.79
|
|
