|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$478.17 |
| Rate for Payer: AlohaCare Medicaid |
$241.50
|
| Rate for Payer: AlohaCare Medicare |
$434.70
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Devoted Health Medicare |
$478.17
|
| 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 |
$434.70
|
| 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 |
$410.55
|
| Rate for Payer: Humana Medicare |
$434.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.70
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060805
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$410.55 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
|
|
HCHG DETECT AGENT NOS DNA AMP - 90
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060799
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$410.55 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
|
|
HCHG DETECTION INFECTIOUS AGENT AMP PROBE
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060714
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$410.55 |
| Max. Negotiated Rate |
$468.51 |
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Health Management Network Commercial |
$410.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
|
|
HCHG DETECTION INFECTIOUS AGENT AMP PROBE
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
H3060714
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$478.17 |
| Rate for Payer: AlohaCare Medicaid |
$241.50
|
| Rate for Payer: AlohaCare Medicare |
$434.70
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Cash Price |
$313.95
|
| Rate for Payer: Devoted Health Medicare |
$478.17
|
| 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 |
$434.70
|
| 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 |
$410.55
|
| Rate for Payer: Humana Medicare |
$434.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.70
|
| Rate for Payer: MDX Hawaii PPO |
$468.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.70
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG DHEA-SULFATE SERUM
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
H3010472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
HCHG DHEA-SULFATE SERUM
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 82627
|
| Hospital Charge Code |
H3010472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$146.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.23
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.20
|
| Rate for Payer: University Health Alliance Commercial |
$57.48
|
|
|
HCHG DIAGNOSTIC IMMUNO TESTING EXTRACTABLE NUCLEAR AB
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$125.13 |
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
|
|
HCHG DIAGNOSTIC IMMUNO TESTING EXTRACTABLE NUCLEAR AB
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3011666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: AlohaCare Medicaid |
$64.50
|
| Rate for Payer: AlohaCare Medicare |
$116.10
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Devoted Health Medicare |
$127.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Humana Medicare |
$116.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG DIGOXIN
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
H3010476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$167.45 |
| Max. Negotiated Rate |
$191.09 |
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
|
|
HCHG DIGOXIN
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
H3010476
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$195.03 |
| Rate for Payer: AlohaCare Medicaid |
$98.50
|
| Rate for Payer: AlohaCare Medicare |
$177.30
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Devoted Health Medicare |
$195.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.28
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Humana Medicare |
$177.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.30
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.30
|
| Rate for Payer: University Health Alliance Commercial |
$34.32
|
|
|
HCHG DILANTIN FREE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
H3010480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: AlohaCare Medicaid |
$52.50
|
| Rate for Payer: AlohaCare Medicare |
$94.50
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Devoted Health Medicare |
$103.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.76
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$94.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.50
|
| Rate for Payer: University Health Alliance Commercial |
$35.58
|
|
|
HCHG DILANTIN FREE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
H3010480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
HCHG DILANTIN TOTAL
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
H3010478
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$99.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
HCHG DILANTIN TOTAL
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
H3010478
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HCHG DISACCHARIDASE ACTIVITY PANEL, TISSUE
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
H3011826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$146.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.17
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.20
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
HCHG DISACCHARIDASE ACTIVITY PANEL, TISSUE
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 82657
|
| Hospital Charge Code |
H3011826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
HCHG DISLOC CLSD ELBOW NM W MANIP
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
H4500394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG DISLOC CLSD ELBOW NM W MANIP
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
H4500394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG DISLOC CLSD TOE (IP)
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
H4500390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$1,397.77 |
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
|
|
HCHG DISLOC CLSD TOE (IP)
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
H4500390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$720.50
|
| Rate for Payer: AlohaCare Medicare |
$1,296.90
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Cash Price |
$936.65
|
| Rate for Payer: Devoted Health Medicare |
$1,426.59
|
| 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 |
$1,296.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,368.95
|
| Rate for Payer: Health Management Network Commercial |
$1,224.85
|
| Rate for Payer: Humana Medicare |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,296.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,296.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,397.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,296.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,296.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,296.90
|
| Rate for Payer: University Health Alliance Commercial |
$1,050.34
|
|
|
HCHG DPYD GENE COMMON 3 VARIANT
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
K3000005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$880.11 |
| Rate for Payer: AlohaCare Medicaid |
$444.50
|
| Rate for Payer: AlohaCare Medicare |
$800.10
|
| Rate for Payer: Cash Price |
$577.85
|
| Rate for Payer: Cash Price |
$577.85
|
| Rate for Payer: Devoted Health Medicare |
$880.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$218.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$800.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.81
|
| Rate for Payer: Health Management Network Commercial |
$755.65
|
| Rate for Payer: Humana Medicare |
$800.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$800.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$453.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$800.10
|
| Rate for Payer: MDX Hawaii PPO |
$862.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$800.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$800.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$800.10
|
| Rate for Payer: University Health Alliance Commercial |
$647.99
|
|
|
HCHG DPYD GENE COMMON 3 VARIANT
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
HCPCS 81232
|
| Hospital Charge Code |
K3000005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$755.65 |
| Max. Negotiated Rate |
$862.33 |
| Rate for Payer: Cash Price |
$577.85
|
| Rate for Payer: Health Management Network Commercial |
$755.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$800.10
|
| Rate for Payer: MDX Hawaii PPO |
$862.33
|
|
|
HCHG DRAIN ABS/HEMA NASL INT APPRCH
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
H4500861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$974.95 |
| Max. Negotiated Rate |
$1,112.59 |
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Health Management Network Commercial |
$974.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,032.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,112.59
|
|
|
HCHG DRAIN ABS/HEMA NASL INT APPRCH
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
H4500861
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$573.50
|
| Rate for Payer: AlohaCare Medicare |
$1,032.30
|
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Cash Price |
$745.55
|
| Rate for Payer: Devoted Health Medicare |
$1,135.53
|
| 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 |
$1,032.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,089.65
|
| Rate for Payer: Health Management Network Commercial |
$974.95
|
| Rate for Payer: Humana Medicare |
$1,032.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,032.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,032.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,112.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,032.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,032.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,032.30
|
| Rate for Payer: University Health Alliance Commercial |
$836.05
|
|
