|
HC MORPH ANALYSIS SO
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
3108836001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.87 |
| 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 |
$38.87
|
| 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 |
$42.44
|
| 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 |
$38.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$526.38
|
| Rate for Payer: University Health Alliance Commercial |
$231.14
|
|
|
HC MORPH ANALYSIS SO
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88360
|
| Hospital Charge Code |
3108836001
|
|
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 MORPHOMETRIC ANALYSIS TUMOR
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
HCPCS 88358
|
| Hospital Charge Code |
3108835801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$1,612.14 |
| Rate for Payer: AlohaCare Medicaid |
$831.00
|
| Rate for Payer: AlohaCare Medicare |
$515.22
|
| Rate for Payer: Cash Price |
$997.20
|
| Rate for Payer: Cash Price |
$997.20
|
| Rate for Payer: Devoted Health Medicare |
$565.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$515.22
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$1,412.70
|
| Rate for Payer: Humana Medicare |
$515.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,495.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$847.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$515.22
|
| Rate for Payer: MDX Hawaii PPO |
$1,612.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$515.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$515.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$515.22
|
| Rate for Payer: University Health Alliance Commercial |
$145.65
|
|
|
HC MORPHOMETRIC ANALYSIS TUMOR
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
HCPCS 88358
|
| Hospital Charge Code |
3108835801
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,412.70 |
| Max. Negotiated Rate |
$1,612.14 |
| Rate for Payer: Cash Price |
$997.20
|
| Rate for Payer: Health Management Network Commercial |
$1,412.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,495.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,612.14
|
|
|
HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
HCPCS 88373
|
| Hospital Charge Code |
3108837301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$623.71 |
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Health Management Network Commercial |
$546.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$578.70
|
| Rate for Payer: MDX Hawaii PPO |
$623.71
|
|
|
HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
HCPCS 88373
|
| Hospital Charge Code |
3108837301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$623.71 |
| Rate for Payer: AlohaCare Medicaid |
$321.50
|
| Rate for Payer: AlohaCare Medicare |
$199.33
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Devoted Health Medicare |
$218.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$199.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$38.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$610.85
|
| Rate for Payer: Health Management Network Commercial |
$546.55
|
| Rate for Payer: Humana Medicare |
$199.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$578.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$327.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$199.33
|
| Rate for Payer: MDX Hawaii PPO |
$623.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$199.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$199.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$199.33
|
| Rate for Payer: University Health Alliance Commercial |
$149.66
|
|
|
HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST
|
Facility
|
OP
|
$3,490.00
|
|
|
Service Code
|
HCPCS 88361
|
| Hospital Charge Code |
3108836101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.41 |
| Max. Negotiated Rate |
$3,385.30 |
| Rate for Payer: AlohaCare Medicaid |
$1,745.00
|
| Rate for Payer: AlohaCare Medicare |
$1,081.90
|
| Rate for Payer: Cash Price |
$2,094.00
|
| Rate for Payer: Cash Price |
$2,094.00
|
| Rate for Payer: Devoted Health Medicare |
$1,186.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$67.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,081.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$2,966.50
|
| Rate for Payer: Humana Medicare |
$1,081.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,141.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,779.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,081.90
|
| Rate for Payer: MDX Hawaii PPO |
$3,385.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,081.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,081.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,081.90
|
| Rate for Payer: University Health Alliance Commercial |
$315.18
|
|
|
HC M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST
|
Facility
|
IP
|
$3,490.00
|
|
|
Service Code
|
HCPCS 88361
|
| Hospital Charge Code |
3108836101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,966.50 |
| Max. Negotiated Rate |
$3,385.30 |
| Rate for Payer: Cash Price |
$2,094.00
|
| Rate for Payer: Health Management Network Commercial |
$2,966.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,141.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,385.30
|
|
|
HC MUMPS - MUMPS IGM ANTIBODY
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
3028673502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$33.79
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Devoted Health Medicare |
$37.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.05
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$33.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.79
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.79
|
| Rate for Payer: University Health Alliance Commercial |
$33.73
|
|
|
HC MUMPS - MUMPS IGM ANTIBODY
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
3028673502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
3018388001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$279.65 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$296.10
|
| Rate for Payer: MDX Hawaii PPO |
$319.13
|
|
|
HC NATRIURETIC PEPTIDE - B-TYPE NATRIURETIC PEPTIDE (BNP)
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
3018388001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$319.13 |
| Rate for Payer: AlohaCare Medicaid |
$164.50
|
| Rate for Payer: AlohaCare Medicare |
$101.99
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Devoted Health Medicare |
$111.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network Commercial |
$279.65
|
| Rate for Payer: Humana Medicare |
$101.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$296.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.99
|
| Rate for Payer: MDX Hawaii PPO |
$319.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.99
|
| Rate for Payer: University Health Alliance Commercial |
$87.75
|
|
|
HC NECROPSY GROSS & MICROSCOPIC W/BRAIN
|
Facility
|
IP
|
$4,167.00
|
|
|
Service Code
|
HCPCS 88025
|
| Hospital Charge Code |
3108802501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3,541.95 |
| Max. Negotiated Rate |
$4,041.99 |
| Rate for Payer: Cash Price |
$2,500.20
|
| Rate for Payer: Health Management Network Commercial |
$3,541.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,750.30
|
| Rate for Payer: MDX Hawaii PPO |
$4,041.99
|
|
|
HC NECROPSY GROSS & MICROSCOPIC W/BRAIN
|
Facility
|
OP
|
$4,167.00
|
|
|
Service Code
|
HCPCS 88025
|
| Hospital Charge Code |
3108802501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,291.77 |
| Max. Negotiated Rate |
$4,041.99 |
| Rate for Payer: AlohaCare Medicaid |
$2,083.50
|
| Rate for Payer: AlohaCare Medicare |
$1,291.77
|
| Rate for Payer: Cash Price |
$2,500.20
|
| Rate for Payer: Devoted Health Medicare |
$1,416.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,291.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,958.65
|
| Rate for Payer: Health Management Network Commercial |
$3,541.95
|
| Rate for Payer: Humana Medicare |
$1,291.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,750.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,125.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,291.77
|
| Rate for Payer: MDX Hawaii PPO |
$4,041.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,291.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,291.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,291.77
|
| Rate for Payer: University Health Alliance Commercial |
$3,037.33
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
7619760701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
7619760701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$1,542.30 |
| 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 Commercial |
$519.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$492.90
|
| 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 |
$810.90
|
| 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 Medicaid |
$20.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$492.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
3068759101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| 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 |
$48.50
|
| 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 |
$50.93
|
| 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 |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC N.GONORRHOEAE, DNA, AMP PROB - GC DNA PCR
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
3068759101
|
|
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 NUCLEAR ANTIGEN ANTIBODY - ENA EA AB
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$75.00
|
| Rate for Payer: AlohaCare Medicare |
$46.50
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Devoted Health Medicare |
$51.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$46.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.50
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HC NUCLEAR ANTIGEN ANTIBODY - ENA EA AB
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
3028623504
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC OBSERVATION CARVE-OUT - GASTROINTESTINAL
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037803
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
|
|
HC OBSERVATION CARVE-OUT - GASTROINTESTINAL
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037803
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: AlohaCare Medicaid |
$87.00
|
| Rate for Payer: AlohaCare Medicare |
$53.94
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$59.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,200.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.30
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Humana Medicare |
$53.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.94
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.94
|
| Rate for Payer: University Health Alliance Commercial |
$126.83
|
|
|
HC OBSERVATION CARVE-OUT - IV INFUSION ADMIN
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037808
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: AlohaCare Medicaid |
$87.00
|
| Rate for Payer: AlohaCare Medicare |
$53.94
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$59.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,200.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.30
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Humana Medicare |
$53.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.94
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.94
|
| Rate for Payer: University Health Alliance Commercial |
$126.83
|
|
|
HC OBSERVATION CARVE-OUT - IV INFUSION ADMIN
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037808
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
|
|
HC OBSERVATION CARVE-OUT - RADIOLOGY
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
762G037802
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: AlohaCare Medicaid |
$87.00
|
| Rate for Payer: AlohaCare Medicare |
$53.94
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Devoted Health Medicare |
$59.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,200.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.30
|
| Rate for Payer: Health Management Network Commercial |
$147.90
|
| Rate for Payer: Humana Medicare |
$53.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$156.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.94
|
| Rate for Payer: MDX Hawaii PPO |
$168.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.94
|
| Rate for Payer: University Health Alliance Commercial |
$126.83
|
|
