|
HCHG STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
H4500696
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$434.56 |
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
|
|
HCHG STRAPPING HAND OR FINGER
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
H4500698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$224.00
|
| Rate for Payer: AlohaCare Medicare |
$403.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Devoted Health Medicare |
$443.52
|
| 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 |
$403.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$425.60
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Humana Medicare |
$403.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$403.20
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$403.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$403.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$403.20
|
| Rate for Payer: University Health Alliance Commercial |
$326.55
|
|
|
HCHG STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
H4500698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$434.56 |
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
|
|
HCHG STRAPPING KNEE
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
H4500700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$408.00
|
| Rate for Payer: AlohaCare Medicare |
$734.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Devoted Health Medicare |
$807.84
|
| 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 |
$734.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Humana Medicare |
$734.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$734.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$734.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$734.40
|
| Rate for Payer: University Health Alliance Commercial |
$594.78
|
|
|
HCHG STRAPPING KNEE
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
H4500700
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Health Management Network Commercial |
$693.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$734.40
|
| Rate for Payer: MDX Hawaii PPO |
$791.52
|
|
|
HCHG STRAPPING SHLDR
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
H4500704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$295.50
|
| Rate for Payer: AlohaCare Medicare |
$531.90
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Devoted Health Medicare |
$585.09
|
| 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 |
$531.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$561.45
|
| Rate for Payer: Health Management Network Commercial |
$502.35
|
| Rate for Payer: Humana Medicare |
$531.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.90
|
| Rate for Payer: MDX Hawaii PPO |
$573.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$531.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$531.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$531.90
|
| Rate for Payer: University Health Alliance Commercial |
$430.78
|
|
|
HCHG STRAPPING SHLDR
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
H4500704
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$502.35 |
| Max. Negotiated Rate |
$573.27 |
| Rate for Payer: Cash Price |
$384.15
|
| Rate for Payer: Health Management Network Commercial |
$502.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.90
|
| Rate for Payer: MDX Hawaii PPO |
$573.27
|
|
|
HCHG STRAPPING THORAX
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
H4500706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$520.00
|
| Rate for Payer: AlohaCare Medicare |
$936.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Devoted Health Medicare |
$1,029.60
|
| 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 |
$936.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$988.00
|
| Rate for Payer: Health Management Network Commercial |
$884.00
|
| Rate for Payer: Humana Medicare |
$936.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$936.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$936.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,008.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$936.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$936.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$936.00
|
| Rate for Payer: University Health Alliance Commercial |
$758.06
|
|
|
HCHG STRAPPING THORAX
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
H4500706
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$884.00 |
| Max. Negotiated Rate |
$1,008.80 |
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Health Management Network Commercial |
$884.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$936.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,008.80
|
|
|
HCHG STRAPPING TOES
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
H4500708
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$385.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$423.72
|
| 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 |
$385.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$385.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.20
|
| Rate for Payer: University Health Alliance Commercial |
$311.97
|
|
|
HCHG STRAPPING TOES
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
H4500708
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
HCHG STRAPPING UNNA BOOT
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
H4500710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$406.50
|
| Rate for Payer: AlohaCare Medicare |
$731.70
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Devoted Health Medicare |
$804.87
|
| 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 |
$731.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$772.35
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Humana Medicare |
$731.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$731.70
|
| Rate for Payer: MDX Hawaii PPO |
$788.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$731.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$731.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$731.70
|
| Rate for Payer: University Health Alliance Commercial |
$592.60
|
|
|
HCHG STRAPPING UNNA BOOT
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
H4500710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$691.05 |
| Max. Negotiated Rate |
$788.61 |
| Rate for Payer: Cash Price |
$528.45
|
| Rate for Payer: Health Management Network Commercial |
$691.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$731.70
|
| Rate for Payer: MDX Hawaii PPO |
$788.61
|
|
|
HCHG STREP A ASSAY W/OPTIC
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
H3060775
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
HCHG STREP A ASSAY W/OPTIC
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
H3060775
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$177.21 |
| Rate for Payer: AlohaCare Medicaid |
$89.50
|
| Rate for Payer: AlohaCare Medicare |
$161.10
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$177.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$161.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.10
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG STREP B DNA AMP PROBE - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
H3060797
|
|
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 STREP B DNA AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87653
|
| Hospital Charge Code |
H3060797
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| 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 |
$49.04
|
| 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 |
$51.49
|
| 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 |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG STREPTOCOCCUS GRP A, AMP PROBE - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
H3060718
|
|
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 STREPTOCOCCUS GRP A, AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87651
|
| Hospital Charge Code |
H3060718
|
|
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 STRIATED MUSCLE AB TITER
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
H3020981
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
HCHG STRIATED MUSCLE AB TITER
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
H3020981
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: AlohaCare Medicaid |
$55.00
|
| Rate for Payer: AlohaCare Medicare |
$99.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$108.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$99.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG SUSCEPTIBILITY PER AGENT
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
K3060015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$35.64 |
| Rate for Payer: AlohaCare Medicaid |
$18.00
|
| Rate for Payer: AlohaCare Medicare |
$32.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Devoted Health Medicare |
$35.64
|
| 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 |
$32.40
|
| 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 |
$30.60
|
| Rate for Payer: Humana Medicare |
$32.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.40
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
HCHG SUSCEPTIBILITY PER AGENT
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
K3060015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$23.40
|
| 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
|
|
|
HCHG SUSCEPTIBILITY, YEAST, COMPREHENSIVE
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060738
|
|
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 SUSCEPTIBILITY, YEAST, COMPREHENSIVE
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060738
|
|
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
|
|
