|
HC SUTURE EYELID WOUND,FULL THICK
|
Facility
|
IP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67935
|
| Hospital Charge Code |
3616793501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,727.35 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
|
|
HC SUTURE EYELID WOUND,PARTIAL THICK
|
Facility
|
OP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
3616793001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: AlohaCare Medicaid |
$4,545.50
|
| Rate for Payer: AlohaCare Medicare |
$2,818.21
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Devoted Health Medicare |
$3,090.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,818.21
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,636.45
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Humana Medicare |
$2,818.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,818.21
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,818.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,818.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,818.21
|
| Rate for Payer: University Health Alliance Commercial |
$6,626.43
|
|
|
HC SUTURE EYELID WOUND,PARTIAL THICK
|
Facility
|
IP
|
$9,091.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
3616793001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,727.35 |
| Max. Negotiated Rate |
$8,818.27 |
| Rate for Payer: Cash Price |
$5,454.60
|
| Rate for Payer: Health Management Network Commercial |
$7,727.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,181.90
|
| Rate for Payer: MDX Hawaii PPO |
$8,818.27
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - RAPID PLASMA REAGIN-SYP
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL QUAL SERUM SO
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL - VDRL QUAL SERUM SO
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
3028659201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC TEMPORARY EXTERNAL PACING
|
Facility
|
OP
|
$2,604.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
4819295301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,525.88 |
| Rate for Payer: AlohaCare Medicaid |
$1,302.00
|
| Rate for Payer: AlohaCare Medicare |
$807.24
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Devoted Health Medicare |
$885.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$807.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,473.80
|
| Rate for Payer: Health Management Network Commercial |
$2,213.40
|
| Rate for Payer: Humana Medicare |
$807.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,343.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$807.24
|
| Rate for Payer: MDX Hawaii PPO |
$2,525.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$807.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$807.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$807.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,898.06
|
|
|
HC TEMPORARY EXTERNAL PACING
|
Facility
|
IP
|
$2,604.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
4819295301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,213.40 |
| Max. Negotiated Rate |
$2,525.88 |
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Health Management Network Commercial |
$2,213.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,343.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,525.88
|
|
|
HC TISSUE EXAM BY KOH - KOH PREP
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
3068722001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$12.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HC TISSUE EXAM BY KOH - KOH PREP
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
3068722001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC TISSUE INSITU HYBRIDIZATI EA
|
Facility
|
IP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
3108836501
|
|
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 TISSUE INSITU HYBRIDIZATI EA
|
Facility
|
OP
|
$1,698.00
|
|
|
Service Code
|
HCPCS 88365
|
| Hospital Charge Code |
3108836501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.74 |
| 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 |
$82.14
|
| 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 |
$52.74
|
| 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 |
$82.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$526.38
|
| Rate for Payer: University Health Alliance Commercial |
$296.04
|
|
|
HC TOE(S) MIN 2V BILAT
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$135.78
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Devoted Health Medicare |
$148.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$135.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.78
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$53.35
|
|
|
HC TOE(S) MIN 2V BILAT
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 73660
|
| Hospital Charge Code |
3207366001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3018446001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
HC TRANSFERASE ALANINE AMINO (ALT) (SGPT) - ALT (SGPT)
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
3018446001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$13.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Devoted Health Medicare |
$14.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.30
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$13.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.64
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.64
|
| Rate for Payer: University Health Alliance Commercial |
$13.69
|
|
|
HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
3018445001
|
|
Hospital Revenue Code
|
301
|
| 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 |
$7.14
|
| 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 |
$7.50
|
| 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 |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.33
|
| Rate for Payer: University Health Alliance Commercial |
$13.36
|
|
|
HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT) - AST (SGOT)
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
3018445001
|
|
Hospital Revenue Code
|
301
|
| 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 TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
4027681701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: AlohaCare Medicaid |
$264.50
|
| Rate for Payer: AlohaCare Medicare |
$163.99
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Devoted Health Medicare |
$179.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Humana Medicare |
$163.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.99
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$193.75
|
|
|
HC TRANSVAGINAL US OBSTETRIC - US OB TRANSVAGINAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
4027681701
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$449.65 |
| Max. Negotiated Rate |
$513.13 |
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Health Management Network Commercial |
$449.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.10
|
| Rate for Payer: MDX Hawaii PPO |
$513.13
|
|
|
HC TREAT THUMB FX/DISLOC,MANIP
|
Facility
|
OP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
7612664501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: AlohaCare Medicaid |
$3,118.00
|
| Rate for Payer: AlohaCare Medicare |
$1,933.16
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Devoted Health Medicare |
$2,120.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,933.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,924.20
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Humana Medicare |
$1,933.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,933.16
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,933.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,933.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,933.16
|
| Rate for Payer: University Health Alliance Commercial |
$4,545.42
|
|
|
HC TREAT THUMB FX/DISLOC,MANIP
|
Facility
|
IP
|
$6,236.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
7612664501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,300.60 |
| Max. Negotiated Rate |
$6,048.92 |
| Rate for Payer: Cash Price |
$3,741.60
|
| Rate for Payer: Health Management Network Commercial |
$5,300.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,612.40
|
| Rate for Payer: MDX Hawaii PPO |
$6,048.92
|
|
|
HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
3018448101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$48.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.94
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$44.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.02
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.02
|
| Rate for Payer: University Health Alliance Commercial |
$43.79
|
|
|
HC TRIIODOTHYRONINE FREE ASSAY (FT-3) - T3 FREE
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
3018448101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
