|
HCHG SVN W PEAK FLOW, DAILY
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100276
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG SVN W PEAK FLOW SUBSEQUENT
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100279
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,243.44 |
| Rate for Payer: AlohaCare Medicaid |
$628.00
|
| Rate for Payer: AlohaCare Medicare |
$1,130.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Devoted Health Medicare |
$1,243.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,130.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,193.20
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Humana Medicare |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$640.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,130.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,130.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,130.40
|
| Rate for Payer: University Health Alliance Commercial |
$915.50
|
|
|
HCHG SVN W PEAK FLOW SUBSEQUENT
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
H4100279
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,067.60 |
| Max. Negotiated Rate |
$1,218.32 |
| Rate for Payer: Cash Price |
$816.40
|
| Rate for Payer: Health Management Network Commercial |
$1,067.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,130.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,218.32
|
|
|
HCHG SYPHILIS TEST NON-TREP RPR, REFLEX TO TITER, QUAL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
H3020756
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$29.70
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Devoted Health Medicare |
$32.67
|
| 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 |
$29.70
|
| 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 |
$28.05
|
| Rate for Payer: Humana Medicare |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.70
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG SYPHILIS TEST NON-TREP RPR, REFLEX TO TITER, QUAL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
H3020756
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
HCHG SYPHILIS TEST NON-TREP RPR TITER, QUANT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
H3020995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicare |
$30.60
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Devoted Health Medicare |
$33.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.40
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.60
|
| Rate for Payer: University Health Alliance Commercial |
$11.40
|
|
|
HCHG SYPHILIS TEST NON-TREP RPR TITER, QUANT
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
H3020995
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$22.10
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
HCHG T3 FREE
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
H3011192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$82.55
|
| 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
|
|
|
HCHG T3 FREE
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
H3011192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$125.73 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$114.30
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$125.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.94
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$114.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.30
|
| Rate for Payer: University Health Alliance Commercial |
$43.79
|
|
|
HCHG T3 TOT
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
H3011194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$97.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Devoted Health Medicare |
$106.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.18
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$97.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.20
|
| Rate for Payer: University Health Alliance Commercial |
$36.65
|
|
|
HCHG T3 TOT
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
H3011194
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$70.20
|
| 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
|
|
|
HCHG T3 UPTAKE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
H3011198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$108.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HCHG T3 UPTAKE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
H3011198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HCHG T4 TOTAL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
H3011456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
HCHG T4 TOTAL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
H3011456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: AlohaCare Medicaid |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$115.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$126.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.87
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$115.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.20
|
| Rate for Payer: University Health Alliance Commercial |
$17.78
|
|
|
HCHG TACROLIMUS
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
H3000384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: AlohaCare Medicaid |
$102.00
|
| Rate for Payer: AlohaCare Medicare |
$183.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Devoted Health Medicare |
$201.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$183.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.73
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Humana Medicare |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$183.60
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$183.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$183.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$183.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.46
|
|
|
HCHG TACROLIMUS
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 80197
|
| Hospital Charge Code |
H3000384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
|
|
HCHG TB, AMP PROBE - 90
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
H3060771
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$306.85 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
HCHG TB, AMP PROBE - 90
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
H3060771
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicare |
$324.90
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Devoted Health Medicare |
$357.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$324.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.68
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Humana Medicare |
$324.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$324.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$324.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$324.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG TBII
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3011206
|
|
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
|
|
|
HCHG TBII
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
H3011206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$135.63 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Devoted Health Medicare |
$135.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.40
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.30
|
| Rate for Payer: University Health Alliance Commercial |
$34.93
|
|
|
HCHG T CELL ABS CD4/CD8 COUNT
|
Facility
|
OP
|
$774.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
H3020847
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$766.26 |
| Rate for Payer: AlohaCare Medicaid |
$387.00
|
| Rate for Payer: AlohaCare Medicare |
$696.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Devoted Health Medicare |
$766.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$696.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.98
|
| Rate for Payer: Health Management Network Commercial |
$657.90
|
| Rate for Payer: Humana Medicare |
$696.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$696.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$394.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$696.60
|
| Rate for Payer: MDX Hawaii PPO |
$750.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$696.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$696.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$696.60
|
| Rate for Payer: University Health Alliance Commercial |
$121.45
|
|
|
HCHG T CELL ABS CD4/CD8 COUNT
|
Facility
|
IP
|
$774.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
H3020847
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$750.78 |
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Health Management Network Commercial |
$657.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$696.60
|
| Rate for Payer: MDX Hawaii PPO |
$750.78
|
|
|
HCHG T CELLS TOTAL COUNT
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
H3110114
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$615.78 |
| Rate for Payer: AlohaCare Medicaid |
$311.00
|
| Rate for Payer: AlohaCare Medicare |
$559.80
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Devoted Health Medicare |
$615.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$559.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.73
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Humana Medicare |
$559.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$317.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$559.80
|
| Rate for Payer: MDX Hawaii PPO |
$603.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$559.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$559.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$559.80
|
| Rate for Payer: University Health Alliance Commercial |
$97.50
|
|
|
HCHG T CELLS TOTAL COUNT
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
H3110114
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$528.70 |
| Max. Negotiated Rate |
$603.34 |
| Rate for Payer: Cash Price |
$404.30
|
| Rate for Payer: Health Management Network Commercial |
$528.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.80
|
| Rate for Payer: MDX Hawaii PPO |
$603.34
|
|
