|
HCHG CULT SPUTUM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULT THROAT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULT THROAT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULT TISSUE OTHER 90
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
H3110156
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$787.05 |
| Rate for Payer: AlohaCare Medicaid |
$397.50
|
| Rate for Payer: AlohaCare Medicare |
$715.50
|
| Rate for Payer: Cash Price |
$516.75
|
| Rate for Payer: Cash Price |
$516.75
|
| Rate for Payer: Devoted Health Medicare |
$787.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$117.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$175.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$715.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$140.73
|
| Rate for Payer: Health Management Network Commercial |
$675.75
|
| Rate for Payer: Humana Medicare |
$715.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$715.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$715.50
|
| Rate for Payer: MDX Hawaii PPO |
$771.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$715.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$715.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$715.50
|
| Rate for Payer: University Health Alliance Commercial |
$363.77
|
|
|
HCHG CULT TISSUE OTHER 90
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 88233
|
| Hospital Charge Code |
H3110156
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$675.75 |
| Max. Negotiated Rate |
$771.15 |
| Rate for Payer: Cash Price |
$516.75
|
| Rate for Payer: Health Management Network Commercial |
$675.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$715.50
|
| Rate for Payer: MDX Hawaii PPO |
$771.15
|
|
|
HCHG CULTURE CATH TIP
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
K3060006
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULTURE CATH TIP
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
K3060006
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULTURE TISSUE AEROBIC
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
HCHG CULTURE TISSUE AEROBIC
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
H3060705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG CULTURE TYPING HERPES SO
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
K3060014
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$14.41
|
|
|
HCHG CULTURE TYPING HERPES SO
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
K3060014
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG CULT URINE
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
H3060180
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$122.76 |
| 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 |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.07
|
| 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 |
$63.24
|
| 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 Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.60
|
| Rate for Payer: University Health Alliance Commercial |
$20.87
|
|
|
HCHG CULT URINE
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
H3060180
|
|
Hospital Revenue Code
|
306
|
| 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 CYCLOSPORINE
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
H3010458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$226.95 |
| Max. Negotiated Rate |
$258.99 |
| Rate for Payer: Cash Price |
$173.55
|
| Rate for Payer: Health Management Network Commercial |
$226.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$240.30
|
| Rate for Payer: MDX Hawaii PPO |
$258.99
|
|
|
HCHG CYCLOSPORINE
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
H3010458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$264.33 |
| Rate for Payer: AlohaCare Medicaid |
$133.50
|
| Rate for Payer: AlohaCare Medicare |
$240.30
|
| Rate for Payer: Cash Price |
$173.55
|
| Rate for Payer: Cash Price |
$173.55
|
| Rate for Payer: Devoted Health Medicare |
$264.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$226.95
|
| Rate for Payer: Humana Medicare |
$240.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$240.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$240.30
|
| Rate for Payer: MDX Hawaii PPO |
$258.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$240.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.30
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
HCHG CYTOGENETICS AND MOLECULAR CYTOGENETICS INTERPRETATION - 90
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
H3100205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.54 |
| 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 |
$16.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.40
|
| 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 |
$16.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$51.10
|
|
|
HCHG CYTOGENETICS AND MOLECULAR CYTOGENETICS INTERPRETATION - 90
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 88291
|
| Hospital Charge Code |
H3100205
|
|
Hospital Revenue Code
|
310
|
| 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 CYTOLOGY ADEQUACY/SMR EXAM
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
H3110158
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$417.35 |
| Max. Negotiated Rate |
$476.27 |
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
|
|
HCHG CYTOLOGY ADEQUACY/SMR EXAM
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 88172
|
| Hospital Charge Code |
H3110158
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$486.09 |
| Rate for Payer: AlohaCare Medicaid |
$245.50
|
| Rate for Payer: AlohaCare Medicare |
$441.90
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Devoted Health Medicare |
$486.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$441.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Humana Medicare |
$441.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$250.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.90
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$441.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$441.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$441.90
|
| Rate for Payer: University Health Alliance Commercial |
$101.12
|
|
|
HCHG CYTOMEGALOVIRUS DNA QUAL PCR
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
H3060182
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| 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 |
$48.50
|
| 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 |
$50.93
|
| 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 |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG CYTOMEGALOVIRUS DNA QUAL PCR
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
H3060182
|
|
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 CYTOMEGALOVIRUS DNA QUANT PCR
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
H3060601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: AlohaCare Medicaid |
$142.50
|
| Rate for Payer: AlohaCare Medicare |
$256.50
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Devoted Health Medicare |
$282.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$53.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$256.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$62.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.84
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Humana Medicare |
$256.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$256.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$256.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$256.50
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HCHG CYTOMEGALOVIRUS DNA QUANT PCR
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
H3060601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
|
|
HCHG CYTOMEG DNA AMP PROBE - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
H3060794
|
|
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 CYTOMEG DNA AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
H3060794
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| 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 |
$48.50
|
| 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 |
$50.93
|
| 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 |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
