|
HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
3018448001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$36.89
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$40.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.18
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Humana Medicare |
$36.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.89
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.89
|
| Rate for Payer: University Health Alliance Commercial |
$36.65
|
|
|
HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
3018448001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HC TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4501171901
|
|
Hospital Revenue Code
|
450
|
| 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 TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
4501171901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$1,600.00 |
| 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 ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$937.50
|
| 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 Medicare |
$73.16
|
| Rate for Payer: University Health Alliance Commercial |
$172.02
|
|
|
HC TTE 2D FU/LTD W/CONT
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
483C892401
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,598.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
|
|
HC TTE 2D FU/LTD W/CONT
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
HCPCS C8924
|
| Hospital Charge Code |
483C892401
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$267.85 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: AlohaCare Medicaid |
$888.00
|
| Rate for Payer: AlohaCare Medicare |
$550.56
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Devoted Health Medicare |
$603.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$445.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$550.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,687.20
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: Humana Medicare |
$550.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,598.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$905.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$550.56
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$550.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$550.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$550.56
|
| Rate for Payer: University Health Alliance Commercial |
$1,294.53
|
|
|
HC TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$6,182.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
3613255101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,254.70 |
| Max. Negotiated Rate |
$5,996.54 |
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Health Management Network Commercial |
$5,254.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,563.80
|
| Rate for Payer: MDX Hawaii PPO |
$5,996.54
|
|
|
HC TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$6,182.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
3613255101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,996.54 |
| Rate for Payer: AlohaCare Medicaid |
$3,091.00
|
| Rate for Payer: AlohaCare Medicare |
$1,916.42
|
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Devoted Health Medicare |
$2,101.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,010.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,916.42
|
| Rate for Payer: Health Management Network Commercial |
$5,254.70
|
| Rate for Payer: Humana Medicare |
$1,916.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,563.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,916.42
|
| Rate for Payer: MDX Hawaii PPO |
$5,996.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,916.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,916.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,916.42
|
| Rate for Payer: University Health Alliance Commercial |
$4,506.06
|
|
|
HC UA MICRO ONLY
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
|
|
HC UA MICRO ONLY
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
3078101501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$8.06
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$8.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Humana Medicare |
$8.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.06
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.06
|
| Rate for Payer: University Health Alliance Commercial |
$7.84
|
|
|
HC UMBILICAL ARTERY CATHETERIZATION FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
4503666001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.90 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.60
|
| Rate for Payer: MDX Hawaii PPO |
$246.38
|
|
|
HC UMBILICAL ARTERY CATHETERIZATION FOR DIAGNOSIS OR THERAPY, NEWBORN
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS 36660
|
| Hospital Charge Code |
4503666001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.74 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$127.00
|
| Rate for Payer: AlohaCare Medicare |
$78.74
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Devoted Health Medicare |
$86.36
|
| 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 |
$78.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$241.30
|
| Rate for Payer: Health Management Network Commercial |
$215.90
|
| Rate for Payer: Humana Medicare |
$78.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$228.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.74
|
| Rate for Payer: MDX Hawaii PPO |
$246.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.74
|
| Rate for Payer: University Health Alliance Commercial |
$185.14
|
|
|
HC UNDER OTHER EMERGENCY SERVICES
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
HCPCS 99288
|
| Hospital Charge Code |
4509928801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.87 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$138.50
|
| Rate for Payer: AlohaCare Medicare |
$85.87
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Devoted Health Medicare |
$94.18
|
| 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 |
$85.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$263.15
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Humana Medicare |
$85.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.87
|
| Rate for Payer: MDX Hawaii PPO |
$268.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.87
|
| Rate for Payer: University Health Alliance Commercial |
$201.91
|
|
|
HC UNDER OTHER EMERGENCY SERVICES
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
HCPCS 99288
|
| Hospital Charge Code |
4509928801
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.45 |
| Max. Negotiated Rate |
$268.69 |
| Rate for Payer: Cash Price |
$166.20
|
| Rate for Payer: Health Management Network Commercial |
$235.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$249.30
|
| Rate for Payer: MDX Hawaii PPO |
$268.69
|
|
|
HC UNLISTED DX RADIOGRAPHIC PROCEDURE
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
3207649901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.48 |
| 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 Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.78
|
| 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 |
$66.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.78
|
| Rate for Payer: University Health Alliance Commercial |
$319.26
|
|
|
HC UNLISTED DX RADIOGRAPHIC PROCEDURE
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 76499
|
| Hospital Charge Code |
3207649901
|
|
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 UNLISTED PROCEDURE, RECTUM
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
4504599901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,519.16 |
| Rate for Payer: AlohaCare Medicaid |
$1,814.00
|
| Rate for Payer: AlohaCare Medicare |
$1,124.68
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Devoted Health Medicare |
$1,233.52
|
| 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 |
$1,124.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,446.60
|
| Rate for Payer: Health Management Network Commercial |
$3,083.80
|
| Rate for Payer: Humana Medicare |
$1,124.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,265.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,124.68
|
| Rate for Payer: MDX Hawaii PPO |
$3,519.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,124.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,124.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,124.68
|
| Rate for Payer: University Health Alliance Commercial |
$2,644.45
|
|
|
HC UNLISTED PROCEDURE, RECTUM
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
4504599901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,083.80 |
| Max. Negotiated Rate |
$3,519.16 |
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Health Management Network Commercial |
$3,083.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,265.20
|
| Rate for Payer: MDX Hawaii PPO |
$3,519.16
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE - POCT KETONE, URINE
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100302
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| 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 |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.89
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HC URINALYSIS, AUTO, W/O SCOPE - POCT KETONE, URINE
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100302
|
|
Hospital Revenue Code
|
307
|
| 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 URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100301
|
|
Hospital Revenue Code
|
307
|
| 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 URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
3078100301
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| 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 |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| 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 |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.89
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - UA REFLEX C&S
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100102
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: AlohaCare Medicaid |
$13.50
|
| Rate for Payer: AlohaCare Medicare |
$8.37
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Devoted Health Medicare |
$9.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Humana Medicare |
$8.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.37
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.37
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - UA REFLEX C&S
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100102
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100101
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
