|
HCHG AMOEBIC AB 90
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
H3020228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HCHG AMPUTATION OF FINGER OR THUMB
|
Facility
|
OP
|
$8,369.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
H4500110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$8,285.31 |
| Rate for Payer: AlohaCare Medicaid |
$4,184.50
|
| Rate for Payer: AlohaCare Medicare |
$7,532.10
|
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Devoted Health Medicare |
$8,285.31
|
| 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 |
$7,532.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,950.55
|
| Rate for Payer: Health Management Network Commercial |
$7,113.65
|
| Rate for Payer: Humana Medicare |
$7,532.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,532.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$7,532.10
|
| Rate for Payer: MDX Hawaii PPO |
$8,117.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7,532.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$7,532.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$7,532.10
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG AMPUTATION OF FINGER OR THUMB
|
Facility
|
IP
|
$8,369.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
H4500110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,113.65 |
| Max. Negotiated Rate |
$8,117.93 |
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Health Management Network Commercial |
$7,113.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,532.10
|
| Rate for Payer: MDX Hawaii PPO |
$8,117.93
|
|
|
HCHG AMYLASE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
H3010218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| 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 |
$8.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.48
|
| 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 |
$8.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
|
|
HCHG AMYLASE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
H3010218
|
|
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 ANA AB
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
K3020002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$217.28 |
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
|
|
HCHG ANA AB
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
K3020002
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: AlohaCare Medicaid |
$112.00
|
| Rate for Payer: AlohaCare Medicare |
$201.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Devoted Health Medicare |
$221.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Humana Medicare |
$201.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$201.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HCHG ANA-BODY FLD
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$217.28 |
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
|
|
HCHG ANA-BODY FLD
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: AlohaCare Medicaid |
$112.00
|
| Rate for Payer: AlohaCare Medicare |
$201.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Devoted Health Medicare |
$221.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Humana Medicare |
$201.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$201.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HCHG ANCA SCREEN, REFLEX TO TITER
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
H3021044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG ANCA SCREEN, REFLEX TO TITER
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
H3021044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| 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 |
$82.80
|
| 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 |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$67.06
|
|
|
HCHG ANGIOTENSIN CONVERTING ENZ 90
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
H3010228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$99.90
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$109.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.60
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$99.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.90
|
| Rate for Payer: University Health Alliance Commercial |
$37.72
|
|
|
HCHG ANGIOTENSIN CONVERTING ENZ 90
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
H3010228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG ANKLE (2 VIEWS)
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
H3200148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| 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 |
$16.41
|
| 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 |
$17.57
|
| 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 |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
HCHG ANKLE (2 VIEWS)
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73600
|
| Hospital Charge Code |
H3200148
|
|
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 ANKLE MIN 3 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
H3200152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.34 |
| 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 |
$17.34
|
| 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 |
$18.95
|
| 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 |
$17.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HCHG ANKLE MIN 3 VIEWS
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
HCPCS 73610
|
| Hospital Charge Code |
H3200152
|
|
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 ANTIBODY SCRN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
H3020240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
HCHG ANTIBODY SCRN
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
H3020240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$88.11 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$80.10
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$88.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.77
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$80.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.10
|
| Rate for Payer: University Health Alliance Commercial |
$50.88
|
|
|
HCHG ANTI-CENTROMERE AB 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3020242
|
|
Hospital Revenue Code
|
302
|
| 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 ANTI-CENTROMERE AB 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
H3020242
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| 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 |
$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 |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG ANTI-DNA DBLE STRAND
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
H3020246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
HCHG ANTI-DNA DBLE STRAND
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
H3020246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: AlohaCare Medicaid |
$52.50
|
| Rate for Payer: AlohaCare Medicare |
$94.50
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Devoted Health Medicare |
$103.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.74
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.50
|
| Rate for Payer: University Health Alliance Commercial |
$35.52
|
|
|
HCHG ANTI-ENA AB
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$119.70
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$131.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$119.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HCHG ANTI-ENA AB
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
