|
HCHG SENSITIVITY ENZYME
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
K3060017
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: AlohaCare Medicaid |
$23.00
|
| Rate for Payer: AlohaCare Medicare |
$41.40
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Devoted Health Medicare |
$45.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Humana Medicare |
$41.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.40
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
HCHG SENSITIVITY FUNGI EA
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$164.90 |
| Max. Negotiated Rate |
$188.18 |
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
|
|
HCHG SENSITIVITY FUNGI EA
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$192.06 |
| Rate for Payer: AlohaCare Medicaid |
$97.00
|
| Rate for Payer: AlohaCare Medicare |
$174.60
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Devoted Health Medicare |
$192.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Humana Medicare |
$174.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.60
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.60
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HCHG SENSITIVITY MIC
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
K3060020
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$315.81 |
| Rate for Payer: AlohaCare Medicaid |
$159.50
|
| Rate for Payer: AlohaCare Medicare |
$287.10
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Devoted Health Medicare |
$315.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Humana Medicare |
$287.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$287.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.10
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
HCHG SENSITIVITY MIC
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
K3060020
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
|
|
HCHG SEROTONIN BLOOD 90
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
H3011144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$207.58 |
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.60
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
|
|
HCHG SEROTONIN BLOOD 90
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
H3011144
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$211.86 |
| Rate for Payer: AlohaCare Medicaid |
$107.00
|
| Rate for Payer: AlohaCare Medicare |
$192.60
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Devoted Health Medicare |
$211.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$38.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$192.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.98
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Humana Medicare |
$192.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.60
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$192.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$192.60
|
| Rate for Payer: University Health Alliance Commercial |
$80.07
|
|
|
HCHG SEROTONIN RELEASE ASSAY, UFH
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
H3020959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HCHG SEROTONIN RELEASE ASSAY, UFH
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
H3020959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$133.65 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$121.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Devoted Health Medicare |
$133.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.37
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$121.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.50
|
| Rate for Payer: University Health Alliance Commercial |
$47.47
|
|
|
HCHG SEROTONIN SERUM
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
H3011146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$207.58 |
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.60
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
|
|
HCHG SEROTONIN SERUM
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
H3011146
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$211.86 |
| Rate for Payer: AlohaCare Medicaid |
$107.00
|
| Rate for Payer: AlohaCare Medicare |
$192.60
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Devoted Health Medicare |
$211.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$38.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$192.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.98
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Humana Medicare |
$192.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$192.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.60
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$192.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$192.60
|
| Rate for Payer: University Health Alliance Commercial |
$80.07
|
|
|
HCHG SGOT
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
H3011150
|
|
Hospital Revenue Code
|
301
|
| 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 |
$7.14
|
| 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 |
$7.50
|
| 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 |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.36
|
|
|
HCHG SGOT
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
H3011150
|
|
Hospital Revenue Code
|
301
|
| 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 SGPT
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
H3011152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| 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 |
$89.10
|
| 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 |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$13.69
|
|
|
HCHG SGPT
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
H3011152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG SHIGA-LIKE TOXIN
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
H3060729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG SHIGA-LIKE TOXIN
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87427
|
| Hospital Charge Code |
H3060729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG SHIGA TOXIN 1
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
K3060049
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: AlohaCare Medicaid |
$72.00
|
| Rate for Payer: AlohaCare Medicare |
$129.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$142.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$129.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG SHIGA TOXIN 1
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
K3060049
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
HCHG SHIGA TOXIN 2
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
K3060050
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: AlohaCare Medicaid |
$72.00
|
| Rate for Payer: AlohaCare Medicare |
$129.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$142.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$129.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG SHIGA TOXIN 2
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
K3060050
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
HCHG SHOULDER 1 VIEW
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
H3200742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
|
|
HCHG SHOULDER 1 VIEW
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73020
|
| Hospital Charge Code |
H3200742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$507.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$558.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$507.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$49.15
|
|
|
HCHG SHOULDER MIN 2 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
|
|
HCHG SHOULDER MIN 2 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73030
|
| Hospital Charge Code |
H3200748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$597.96 |
| Rate for Payer: AlohaCare Medicaid |
$302.00
|
| Rate for Payer: AlohaCare Medicare |
$543.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Devoted Health Medicare |
$597.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Humana Medicare |
$543.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$61.92
|
|
