|
HCHG CARDIOLIPIN IGA AB
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020380
|
|
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 CARDIOLIPIN IGG AB
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020382
|
|
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 CARDIOLIPIN IGG AB
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020382
|
|
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 |
$35.16
|
| 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 |
$36.92
|
| 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 |
$35.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.80
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG CARDIOLIPIN IGM AB
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020384
|
|
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 CARDIOLIPIN IGM AB
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 86147
|
| Hospital Charge Code |
H3020384
|
|
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 |
$35.16
|
| 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 |
$36.92
|
| 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 |
$35.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$163.80
|
| Rate for Payer: University Health Alliance Commercial |
$65.75
|
|
|
HCHG CARDIOVERSION
|
Facility
|
IP
|
$3,306.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
H4500158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,810.10 |
| Max. Negotiated Rate |
$3,206.82 |
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Health Management Network Commercial |
$2,810.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,975.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,206.82
|
|
|
HCHG CARDIOVERSION
|
Facility
|
OP
|
$3,306.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
H4500158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,653.00
|
| Rate for Payer: AlohaCare Medicare |
$2,975.40
|
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Cash Price |
$2,148.90
|
| Rate for Payer: Devoted Health Medicare |
$3,272.94
|
| 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 |
$2,975.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,140.70
|
| Rate for Payer: Health Management Network Commercial |
$2,810.10
|
| Rate for Payer: Humana Medicare |
$2,975.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,975.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,975.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,206.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,975.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,975.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,975.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
H4501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$62.00
|
| Rate for Payer: AlohaCare Medicare |
$111.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Devoted Health Medicare |
$122.76
|
| 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 |
$111.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.80
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Humana Medicare |
$111.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.60
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.60
|
| Rate for Payer: University Health Alliance Commercial |
$90.38
|
|
|
HCHG CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
H4501160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.40 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.60
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
|
|
HCHG CARNITINE FREE & TOTAL QUANT
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
H3010322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$113.40
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Devoted Health Medicare |
$124.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.31
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$113.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.87
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$113.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$113.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$113.40
|
| Rate for Payer: University Health Alliance Commercial |
$43.60
|
|
|
HCHG CARNITINE FREE & TOTAL QUANT
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 82379
|
| Hospital Charge Code |
H3010322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
HCHG CATECHOLAMINE-PLASMA FRACTIONATED
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
H3010326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$179.19 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: AlohaCare Medicare |
$162.90
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Devoted Health Medicare |
$179.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.25
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Humana Medicare |
$162.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.90
|
| Rate for Payer: University Health Alliance Commercial |
$65.27
|
|
|
HCHG CATECHOLAMINE-PLASMA FRACTIONATED
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
H3010326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
HCHG CATECHOLAMINES 24 HR URINE FRACTIONATED
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
H3010328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$179.19 |
| Rate for Payer: AlohaCare Medicaid |
$90.50
|
| Rate for Payer: AlohaCare Medicare |
$162.90
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Devoted Health Medicare |
$179.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.25
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Humana Medicare |
$162.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$92.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.90
|
| Rate for Payer: University Health Alliance Commercial |
$65.27
|
|
|
HCHG CATECHOLAMINES 24 HR URINE FRACTIONATED
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
H3010328
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.85 |
| Max. Negotiated Rate |
$175.57 |
| Rate for Payer: Cash Price |
$117.65
|
| Rate for Payer: Health Management Network Commercial |
$153.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.90
|
| Rate for Payer: MDX Hawaii PPO |
$175.57
|
|
|
HCHG CATHETERIZE FOR URINE SPEC
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
H3001112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$53.10
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$58.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.05
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Humana Medicare |
$53.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.10
|
| Rate for Payer: University Health Alliance Commercial |
$43.01
|
|
|
HCHG CATHETERIZE FOR URINE SPEC
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
H3001112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
|
|
HCHG CATH TIP CULT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
H3060120
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.91 |
| 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 |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.89
|
| 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 |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.40
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HCHG CATH TIP CULT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
H3060120
|
|
Hospital Revenue Code
|
306
|
| 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 CBC W DIFF
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
H3000186
|
|
Hospital Revenue Code
|
305
|
| 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 CBC W DIFF
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
H3000186
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| 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 |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| 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 |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.60
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
HCHG CBC WO DIFF
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
H3050124
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$98.10
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Devoted Health Medicare |
$107.91
|
| 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 |
$98.10
|
| 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 |
$92.65
|
| Rate for Payer: Humana Medicare |
$98.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.10
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
HCHG CBC WO DIFF
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
H3050124
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HCHG C-CITRULLINATED PEPTIDE 90
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
H3010334
|
|
Hospital Revenue Code
|
302
|
| 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 C-CITRULLINATED PEPTIDE 90
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
H3010334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.66 |
| 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 |
$12.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.95
|
| 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 |
$12.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
