|
HCHG CHLAMYDIA PCR
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060124
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$228.69 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$207.90
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$228.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Humana Medicare |
$207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG CHLAMYDIA TRACHOMATIS PCR
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060126
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$228.69 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$207.90
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$228.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Humana Medicare |
$207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG CHLAMYDIA TRACHOMATIS PCR
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060126
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
|
|
HCHG CHLMY TRCH&NEISRA GONOR MULT - 90
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 87494
|
| Hospital Charge Code |
H3060820
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$398.97 |
| Rate for Payer: AlohaCare Medicaid |
$201.50
|
| Rate for Payer: AlohaCare Medicare |
$362.70
|
| Rate for Payer: Cash Price |
$261.95
|
| Rate for Payer: Cash Price |
$261.95
|
| Rate for Payer: Devoted Health Medicare |
$398.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$362.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.18
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Humana Medicare |
$362.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$205.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$362.70
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$362.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$362.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$362.70
|
| Rate for Payer: University Health Alliance Commercial |
$293.75
|
|
|
HCHG CHLMY TRCH&NEISRA GONOR MULT - 90
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
HCPCS 87494
|
| Hospital Charge Code |
H3060820
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$342.55 |
| Max. Negotiated Rate |
$390.91 |
| Rate for Payer: Cash Price |
$261.95
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
|
|
HCHG CHLORIDE BLOOD
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 82435
|
| Hospital Charge Code |
H3010342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
HCHG CHLORIDE BLOOD
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 82435
|
| Hospital Charge Code |
H3010342
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: AlohaCare Medicaid |
$16.00
|
| Rate for Payer: AlohaCare Medicare |
$28.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Devoted Health Medicare |
$31.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.60
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$28.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.80
|
| Rate for Payer: University Health Alliance Commercial |
$11.88
|
|
|
HCHG CHLORIDE-URINE
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
H3010352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$43.56 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$39.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Devoted Health Medicare |
$43.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$39.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.60
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
HCHG CHLORIDE-URINE
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
H3010352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
HCHG CHOLESTEROL DIR LDL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
H3010362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: AlohaCare Medicaid |
$40.00
|
| Rate for Payer: AlohaCare Medicare |
$72.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Devoted Health Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.50
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Humana Medicare |
$72.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.00
|
| Rate for Payer: MDX Hawaii PPO |
$77.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.00
|
| Rate for Payer: University Health Alliance Commercial |
$24.66
|
|
|
HCHG CHOLESTEROL DIR LDL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
H3010362
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$77.60 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Management Network Commercial |
$68.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.00
|
| Rate for Payer: MDX Hawaii PPO |
$77.60
|
|
|
HCHG CHOLESTEROL TOTAL
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
H3010356
|
|
Hospital Revenue Code
|
301
|
| 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 CHOLESTEROL TOTAL
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
H3010356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.35 |
| 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 |
$6.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.35
|
| 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 |
$6.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.60
|
| Rate for Payer: University Health Alliance Commercial |
$11.25
|
|
|
HCHG CHROM ANALY 20-25 CELLS
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
H3110288
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$691.90 |
| Max. Negotiated Rate |
$789.58 |
| Rate for Payer: Cash Price |
$529.10
|
| Rate for Payer: Health Management Network Commercial |
$691.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$732.60
|
| Rate for Payer: MDX Hawaii PPO |
$789.58
|
|
|
HCHG CHROM ANALY 20-25 CELLS
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 88264
|
| Hospital Charge Code |
H3110288
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$104.48 |
| Max. Negotiated Rate |
$805.86 |
| Rate for Payer: AlohaCare Medicaid |
$407.00
|
| Rate for Payer: AlohaCare Medicare |
$732.60
|
| Rate for Payer: Cash Price |
$529.10
|
| Rate for Payer: Cash Price |
$529.10
|
| Rate for Payer: Devoted Health Medicare |
$805.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$180.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$732.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.61
|
| Rate for Payer: Health Management Network Commercial |
$691.90
|
| Rate for Payer: Humana Medicare |
$732.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$732.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$415.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$732.60
|
| Rate for Payer: MDX Hawaii PPO |
$789.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$732.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$732.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$732.60
|
| Rate for Payer: University Health Alliance Commercial |
$322.16
|
|
|
HCHG CHROM ANALY ADD KARYO EA
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
H3110289
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$220.77 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$200.70
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$220.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$41.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.47
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$200.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.70
|
| Rate for Payer: University Health Alliance Commercial |
$64.88
|
|
|
HCHG CHROM ANALY ADD KARYO EA
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 88280
|
| Hospital Charge Code |
H3110289
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
HCHG CHROMOGRANIN A
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
H3020908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CHROMOGRANIN A
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
H3020908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG CHROMOSOME ANALYS BLD X 90
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
H3110138
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$612.85 |
| Max. Negotiated Rate |
$699.37 |
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Health Management Network Commercial |
$612.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$648.90
|
| Rate for Payer: MDX Hawaii PPO |
$699.37
|
|
|
HCHG CHROMOSOME ANALYS BLD X 90
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS 88262
|
| Hospital Charge Code |
H3110138
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$124.02 |
| Max. Negotiated Rate |
$713.79 |
| Rate for Payer: AlohaCare Medicaid |
$360.50
|
| Rate for Payer: AlohaCare Medicare |
$648.90
|
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Devoted Health Medicare |
$713.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$124.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$156.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$648.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$172.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.49
|
| Rate for Payer: Health Management Network Commercial |
$612.85
|
| Rate for Payer: Humana Medicare |
$648.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$648.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$367.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$648.90
|
| Rate for Payer: MDX Hawaii PPO |
$699.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$648.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$648.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$648.90
|
| Rate for Payer: University Health Alliance Commercial |
$322.16
|
|
|
HCHG CHYLMD PNEUM DNA AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
H3060801
|
|
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 CHYLMD PNEUM DNA AMP PROBE - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87486
|
| Hospital Charge Code |
H3060801
|
|
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 CK MB 90
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
H3010382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$79.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$87.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.55
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.84
|
|
|
HCHG CK MB 90
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
H3010382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
