|
HCHG BASIC METABOLIC PROFILE
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
H3010262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG BCR-ABL1 P210 SO
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
K3090005
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$855.54 |
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Health Management Network Commercial |
$749.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.80
|
| Rate for Payer: MDX Hawaii PPO |
$855.54
|
|
|
HCHG BCR-ABL1 P210 SO
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
K3090005
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$873.18 |
| Rate for Payer: AlohaCare Medicaid |
$441.00
|
| Rate for Payer: AlohaCare Medicare |
$793.80
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Devoted Health Medicare |
$873.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$219.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$204.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$219.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.96
|
| Rate for Payer: Health Management Network Commercial |
$749.70
|
| Rate for Payer: Humana Medicare |
$793.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$793.80
|
| Rate for Payer: MDX Hawaii PPO |
$855.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$793.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.80
|
| Rate for Payer: University Health Alliance Commercial |
$200.48
|
|
|
HCHG BCR/ABL GENE REARRANGEMENT
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
H3100162
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$873.18 |
| Rate for Payer: AlohaCare Medicaid |
$441.00
|
| Rate for Payer: AlohaCare Medicare |
$793.80
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Devoted Health Medicare |
$873.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$219.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$204.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$219.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.96
|
| Rate for Payer: Health Management Network Commercial |
$749.70
|
| Rate for Payer: Humana Medicare |
$793.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$793.80
|
| Rate for Payer: MDX Hawaii PPO |
$855.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$793.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.80
|
| Rate for Payer: University Health Alliance Commercial |
$200.48
|
|
|
HCHG BCR/ABL GENE REARRANGEMENT
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
H3100162
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$749.70 |
| Max. Negotiated Rate |
$855.54 |
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Health Management Network Commercial |
$749.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$793.80
|
| Rate for Payer: MDX Hawaii PPO |
$855.54
|
|
|
HCHG BETA-2 GLYCOPROTEIN 1 AB EA
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
H3050108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.80
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
|
|
HCHG BETA-2 GLYCOPROTEIN 1 AB EA
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
H3050108
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$180.18 |
| Rate for Payer: AlohaCare Medicaid |
$91.00
|
| Rate for Payer: AlohaCare Medicare |
$163.80
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Devoted Health Medicare |
$180.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.80
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.80
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG BETA-2 GLYCOPROTEIN 1 AB EA
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
H3050104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$180.18 |
| Rate for Payer: AlohaCare Medicaid |
$91.00
|
| Rate for Payer: AlohaCare Medicare |
$163.80
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Devoted Health Medicare |
$180.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$163.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.80
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$163.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.80
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG BETA-2 GLYCOPROTEIN 1 AB EA
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 86146
|
| Hospital Charge Code |
H3050104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: Cash Price |
$118.30
|
| Rate for Payer: Health Management Network Commercial |
$154.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.80
|
| Rate for Payer: MDX Hawaii PPO |
$176.54
|
|
|
HCHG BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
H3010272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HCHG BETA-2 MICROGLOBULIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
H3010272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$120.78 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$109.80
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$120.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.18
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$109.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.80
|
| Rate for Payer: University Health Alliance Commercial |
$41.83
|
|
|
HCHG BETA-2 MICROGLOBULIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
H3010270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$120.78 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$109.80
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$120.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.18
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$109.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.80
|
| Rate for Payer: University Health Alliance Commercial |
$41.83
|
|
|
HCHG BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82232
|
| Hospital Charge Code |
H3010270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HCHG BETA-2 TRANSFERRIN
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
K3020021
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$436.59 |
| Rate for Payer: AlohaCare Medicaid |
$220.50
|
| Rate for Payer: AlohaCare Medicare |
$396.90
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Devoted Health Medicare |
$436.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$396.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.35
|
| Rate for Payer: Health Management Network Commercial |
$374.85
|
| Rate for Payer: Humana Medicare |
$396.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$396.90
|
| Rate for Payer: MDX Hawaii PPO |
$427.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$396.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$396.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$396.90
|
| Rate for Payer: University Health Alliance Commercial |
$75.85
|
|
|
HCHG BETA-2 TRANSFERRIN
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 86335
|
| Hospital Charge Code |
K3020021
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$374.85 |
| Max. Negotiated Rate |
$427.77 |
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Health Management Network Commercial |
$374.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.90
|
| Rate for Payer: MDX Hawaii PPO |
$427.77
|
|
|
HCHG BETA-HYDROXYBUTYRATE
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
H3011599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HCHG BETA-HYDROXYBUTYRATE
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 82010
|
| Hospital Charge Code |
H3011599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$56.70
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.70
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
HCHG BILIRUBIN-BODY FLD TOTAL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
H3010282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
|
|
HCHG BILIRUBIN-BODY FLD TOTAL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
H3010282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$75.24 |
| Rate for Payer: AlohaCare Medicaid |
$38.00
|
| Rate for Payer: AlohaCare Medicare |
$68.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$75.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Humana Medicare |
$68.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.40
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
HCHG BILIRUBIN DIR
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
H3010274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
|
|
HCHG BILIRUBIN DIR
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
H3010274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$38.61 |
| Rate for Payer: AlohaCare Medicaid |
$19.50
|
| Rate for Payer: AlohaCare Medicare |
$35.10
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Devoted Health Medicare |
$38.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Humana Medicare |
$35.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.10
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
HCHG BILIRUBIN TOT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
H3010278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
|
|
HCHG BILIRUBIN TOT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
H3010278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$75.24 |
| Rate for Payer: AlohaCare Medicaid |
$38.00
|
| Rate for Payer: AlohaCare Medicare |
$68.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$75.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Humana Medicare |
$68.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.40
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
HCHG BIPAP/CPAP, DAILY
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
H4100280
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$1,007.82 |
| Rate for Payer: AlohaCare Medicaid |
$509.00
|
| Rate for Payer: AlohaCare Medicare |
$916.20
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Devoted Health Medicare |
$1,007.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$916.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$967.10
|
| Rate for Payer: Health Management Network Commercial |
$865.30
|
| Rate for Payer: Humana Medicare |
$916.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$916.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$519.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$916.20
|
| Rate for Payer: MDX Hawaii PPO |
$987.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$916.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$916.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$916.20
|
| Rate for Payer: University Health Alliance Commercial |
$742.02
|
|
|
HCHG BIPAP/CPAP, DAILY
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
H4100280
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$865.30 |
| Max. Negotiated Rate |
$987.46 |
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Health Management Network Commercial |
$865.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$916.20
|
| Rate for Payer: MDX Hawaii PPO |
$987.46
|
|
