|
HCHG MOLECULAR CYTOGENETICS, DNA PROBE 90
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
H3110286
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$150.35 |
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
|
|
HCHG MOLECULAR CYTOGENETICS, DNA PROBE 90
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
H3110286
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$153.45 |
| Rate for Payer: AlohaCare Medicaid |
$77.50
|
| Rate for Payer: AlohaCare Medicare |
$139.50
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Cash Price |
$100.75
|
| Rate for Payer: Devoted Health Medicare |
$153.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.42
|
| Rate for Payer: Health Management Network Commercial |
$131.75
|
| Rate for Payer: Humana Medicare |
$139.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.50
|
| Rate for Payer: MDX Hawaii PPO |
$150.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$139.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.37
|
|
|
HCHG MOLECULAR CYTOGEN,INTERPHASE INSITU 100-300 CELLS
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
H3110282
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$329.67 |
| Rate for Payer: AlohaCare Medicaid |
$166.50
|
| Rate for Payer: AlohaCare Medicare |
$299.70
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Devoted Health Medicare |
$329.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$63.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$299.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.19
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Humana Medicare |
$299.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$169.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$299.70
|
| Rate for Payer: MDX Hawaii PPO |
$323.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$299.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$299.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$299.70
|
| Rate for Payer: University Health Alliance Commercial |
$103.80
|
|
|
HCHG MOLECULAR CYTOGEN,INTERPHASE INSITU 100-300 CELLS
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 88275
|
| Hospital Charge Code |
H3110282
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$323.01 |
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Health Management Network Commercial |
$283.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.70
|
| Rate for Payer: MDX Hawaii PPO |
$323.01
|
|
|
HCHG MONKEYPOX, DNA, PCR – LABCORP-90
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
H3060766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$500.65 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.10
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
|
|
HCHG MONKEYPOX, DNA, PCR – LABCORP-90
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 87593
|
| Hospital Charge Code |
H3060766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$583.11 |
| Rate for Payer: AlohaCare Medicaid |
$294.50
|
| Rate for Payer: AlohaCare Medicare |
$530.10
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Devoted Health Medicare |
$583.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$64.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$530.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.31
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Humana Medicare |
$530.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$530.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$530.10
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$530.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$530.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$530.10
|
| Rate for Payer: University Health Alliance Commercial |
$429.32
|
|
|
HCHG MONO SCRN SPECIFIC
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
H3020636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
HCHG MONO SCRN SPECIFIC
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
H3020636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$97.02 |
| Rate for Payer: AlohaCare Medicaid |
$49.00
|
| Rate for Payer: AlohaCare Medicare |
$88.20
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$97.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$88.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HCHG MORPH INSITU HYBRID MANUAL EA MULTIPLEX
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
H3120334
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HCHG MORPH INSITU HYBRID MANUAL EA MULTIPLEX
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 88377
|
| Hospital Charge Code |
H3120334
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$884.71 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$139.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$475.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$148.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$126.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.90
|
| Rate for Payer: University Health Alliance Commercial |
$884.71
|
|
|
HCHG MPL CODON ANALYSIS SO
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 81338
|
| Hospital Charge Code |
K3100005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$433.50 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
|
|
HCHG MPL CODON ANALYSIS SO
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 81338
|
| Hospital Charge Code |
K3100005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: AlohaCare Medicaid |
$255.00
|
| Rate for Payer: AlohaCare Medicare |
$459.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Devoted Health Medicare |
$504.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$187.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$459.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.33
|
| Rate for Payer: Health Management Network Commercial |
$433.50
|
| Rate for Payer: Humana Medicare |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$459.00
|
| Rate for Payer: MDX Hawaii PPO |
$494.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$459.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$459.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$459.00
|
| Rate for Payer: University Health Alliance Commercial |
$371.74
|
|
|
HCHG M.PNEUMONIAE DNA AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
H3060803
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG M.PNEUMONIAE DNA AMP PROBE - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87581
|
| Hospital Charge Code |
H3060803
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HCHG MRSA RAPID TEST
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
H3000314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$37.62 |
| Rate for Payer: AlohaCare Medicaid |
$19.00
|
| Rate for Payer: AlohaCare Medicare |
$34.20
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Devoted Health Medicare |
$37.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Humana Medicare |
$34.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.20
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HCHG MRSA RAPID TEST
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
H3000314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.20
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
|
|
HCHG MTHFR (GENE ANALYSIS COMM VARIANTS)
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
H3100163
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$349.35 |
| Max. Negotiated Rate |
$398.67 |
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.90
|
| Rate for Payer: MDX Hawaii PPO |
$398.67
|
|
|
HCHG MTHFR (GENE ANALYSIS COMM VARIANTS)
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
H3100163
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$406.89 |
| Rate for Payer: AlohaCare Medicaid |
$205.50
|
| Rate for Payer: AlohaCare Medicare |
$369.90
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Cash Price |
$267.15
|
| Rate for Payer: Devoted Health Medicare |
$406.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$369.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.34
|
| Rate for Payer: Health Management Network Commercial |
$349.35
|
| Rate for Payer: Humana Medicare |
$369.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$369.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$209.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$369.90
|
| Rate for Payer: MDX Hawaii PPO |
$398.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$369.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$369.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$369.90
|
| Rate for Payer: University Health Alliance Commercial |
$110.17
|
|
|
HCHG MUMPS AB IGG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
H3021012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| 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 |
$90.00
|
| 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 |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.73
|
|
|
HCHG MUMPS AB IGG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
H3021012
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG MUMPS AB IGG 90
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
H3020638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| 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 |
$90.00
|
| 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 |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.73
|
|
|
HCHG MUMPS AB IGG 90
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
H3020638
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG MUMPS AB IGM 90
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
H3020640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG MUMPS AB IGM 90
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86735
|
| Hospital Charge Code |
H3020640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| 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 |
$90.00
|
| 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 |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.73
|
|
|
HCHG MYASTHENIA GRAVIS PANEL 2 - 90
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3011754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
