|
HC URINALYSIS, AUTO, W/SCOPE - URINALYSIS MICROSCOPIC
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
3078100101
|
|
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 NONAUTO W/O SCOPE
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: AlohaCare Medicaid |
$14.50
|
| Rate for Payer: AlohaCare Medicare |
$8.99
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Devoted Health Medicare |
$9.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Humana Medicare |
$8.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.99
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.99
|
| Rate for Payer: University Health Alliance Commercial |
$6.60
|
|
|
HC URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
3078100201
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$22.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Devoted Health Medicare |
$24.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.61
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$22.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.32
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.32
|
| Rate for Payer: University Health Alliance Commercial |
$16.35
|
|
|
HC URINE PREGNANCY TEST - PREGNANCY URINE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
3078102501
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$69.84 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
|
|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670506
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| 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 |
$46.98
|
| 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 |
$50.90
|
| 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 |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$200.93
|
|
|
HC US, ABDOMEN LIMITED - US ABDOMEN LIMITED
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670506
|
|
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 US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670501
|
|
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 US, ABDOMEN LIMITED - US ABDOMEN LIMITED SPLEEN
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
4027670501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| 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 |
$46.98
|
| 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 |
$50.90
|
| 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 |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$200.93
|
|
|
HC US, CHEST,REAL TIME - US CHEST
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660401
|
|
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 US, CHEST,REAL TIME - US CHEST
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
4027660401
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| 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 |
$42.98
|
| 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 |
$46.81
|
| 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 |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
HC US LMTD JT/NONVASC XTR STRUX - US KNEE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688201
|
|
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 US LMTD JT/NONVASC XTR STRUX - US KNEE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
4027688201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.22 |
| 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 |
$7.22
|
| 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 |
$10.72
|
| 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 |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$60.62
|
|
|
HC US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
HCPCS 76813
|
| Hospital Charge Code |
4027681301
|
|
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 US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
HCPCS 76813
|
| Hospital Charge Code |
4027681301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.01 |
| 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 |
$54.01
|
| 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 |
$64.95
|
| 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 |
$54.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.99
|
| Rate for Payer: University Health Alliance Commercial |
$260.13
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
3028678701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$36.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$33.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.48
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.48
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
3028678701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
3028678702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$36.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$33.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.48
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.48
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
3028678702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC VIRAL ID TISS CULT ADD SO
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
3068725301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: AlohaCare Medicaid |
$84.50
|
| Rate for Payer: AlohaCare Medicare |
$52.39
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$57.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.20
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Humana Medicare |
$52.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.39
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.39
|
| Rate for Payer: University Health Alliance Commercial |
$23.18
|
|
|
HC VIRAL ID TISS CULT ADD SO
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
3068725301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$163.93 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$143.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.10
|
| Rate for Payer: MDX Hawaii PPO |
$163.93
|
|
|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$39.37
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Devoted Health Medicare |
$43.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$39.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.37
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.37
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
|
HC VITAMIN B-12 - VITAMIN B12
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
3018260701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
HC WRIGHTS STAIN WBC(STOOL) W/INT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720501
|
|
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 WRIGHTS STAIN WBC(STOOL) W/INT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
3068720501
|
|
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
|
|
