|
HCHG HEMATOCRIT
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 85014
|
| Hospital Charge Code |
H3050156
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG HEMOCHROMATOSIS
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 81256
|
| Hospital Charge Code |
H3100161
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$770.22 |
| Rate for Payer: AlohaCare Medicaid |
$389.00
|
| Rate for Payer: AlohaCare Medicare |
$700.20
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Devoted Health Medicare |
$770.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$87.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$81.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$700.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$87.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.36
|
| Rate for Payer: Health Management Network Commercial |
$661.30
|
| Rate for Payer: Humana Medicare |
$700.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$396.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$700.20
|
| Rate for Payer: MDX Hawaii PPO |
$754.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$700.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$700.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$700.20
|
| Rate for Payer: University Health Alliance Commercial |
$164.96
|
|
|
HCHG HEMOCHROMATOSIS
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 81256
|
| Hospital Charge Code |
H3100161
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$661.30 |
| Max. Negotiated Rate |
$754.66 |
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Health Management Network Commercial |
$661.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.20
|
| Rate for Payer: MDX Hawaii PPO |
$754.66
|
|
|
HCHG HEMOGLOBIN
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
H3050160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
|
|
HCHG HEMOGLOBIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
H3050160
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: AlohaCare Medicaid |
$23.00
|
| Rate for Payer: AlohaCare Medicare |
$41.40
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Devoted Health Medicare |
$45.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Humana Medicare |
$41.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.40
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
HCHG HEMOGLOBIN A1C HPLC
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
H3010714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$159.39 |
| Rate for Payer: AlohaCare Medicaid |
$80.50
|
| Rate for Payer: AlohaCare Medicare |
$144.90
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Devoted Health Medicare |
$159.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.71
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Humana Medicare |
$144.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.90
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.90
|
| Rate for Payer: University Health Alliance Commercial |
$25.09
|
|
|
HCHG HEMOGLOBIN A1C HPLC
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 83036
|
| Hospital Charge Code |
H3010714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.85 |
| Max. Negotiated Rate |
$156.17 |
| Rate for Payer: Cash Price |
$104.65
|
| Rate for Payer: Health Management Network Commercial |
$136.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.90
|
| Rate for Payer: MDX Hawaii PPO |
$156.17
|
|
|
HCHG HEMOGLOBINOPATHY SCRN
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
H3010718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HCHG HEMOGLOBINOPATHY SCRN
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 83021
|
| Hospital Charge Code |
H3010718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$131.67 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$119.70
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Cash Price |
$86.45
|
| Rate for Payer: Devoted Health Medicare |
$131.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.06
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$119.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
HCHG HEP A AB IGM
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
H3020524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$85.14 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$77.40
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Devoted Health Medicare |
$85.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.26
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$77.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.40
|
| Rate for Payer: University Health Alliance Commercial |
$29.10
|
|
|
HCHG HEP A AB IGM
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
H3020524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
HCHG HEPARIN ASSAY LMWH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
H3050168
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG HEPARIN ASSAY LMWH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
H3050168
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.09
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$29.56
|
|
|
HCHG HEPARIN ASSAY UNFRACTIONATED
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
H3050170
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.09
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$29.56
|
|
|
HCHG HEPARIN ASSAY UNFRACTIONATED
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 85520
|
| Hospital Charge Code |
H3050170
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG HEPARIN INDUCED AB
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
H3020550
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
HCHG HEPARIN INDUCED AB
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
H3020550
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$133.65 |
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$121.50
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Devoted Health Medicare |
$133.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.37
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Humana Medicare |
$121.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.50
|
| Rate for Payer: University Health Alliance Commercial |
$47.47
|
|
|
HCHG HEPATIC FUNCTION
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
H3010722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HCHG HEPATIC FUNCTION
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
H3010722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$56.70
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.70
|
| Rate for Payer: University Health Alliance Commercial |
$21.13
|
|
|
HCHG HEPATITIS A IGG ANTIBODY, SERUM
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
H3020526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
|
|
HCHG HEPATITIS A IGG ANTIBODY, SERUM
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 86708
|
| Hospital Charge Code |
H3020526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$94.05 |
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$85.50
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Devoted Health Medicare |
$94.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.39
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Humana Medicare |
$85.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.50
|
| Rate for Payer: University Health Alliance Commercial |
$32.02
|
|
|
HCHG HEPATITIS B VIRUS GENOTYPE
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 87912
|
| Hospital Charge Code |
H3100160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$212.33 |
| Max. Negotiated Rate |
$1,306.80 |
| Rate for Payer: AlohaCare Medicaid |
$660.00
|
| Rate for Payer: AlohaCare Medicare |
$1,188.00
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Devoted Health Medicare |
$1,306.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$256.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$321.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,188.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$355.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$257.45
|
| Rate for Payer: Health Management Network Commercial |
$1,122.00
|
| Rate for Payer: Humana Medicare |
$1,188.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$673.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,188.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,280.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,188.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,188.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,188.00
|
| Rate for Payer: University Health Alliance Commercial |
$654.68
|
|
|
HCHG HEPATITIS B VIRUS GENOTYPE
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
HCPCS 87912
|
| Hospital Charge Code |
H3100160
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$1,280.40 |
| Rate for Payer: Cash Price |
$858.00
|
| Rate for Payer: Health Management Network Commercial |
$1,122.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,188.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,280.40
|
|
|
HCHG HEP BC AB IGM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
H3020534
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$81.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Devoted Health Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.77
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$81.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.00
|
| Rate for Payer: University Health Alliance Commercial |
$30.41
|
|
|
HCHG HEP BC AB IGM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 86705
|
| Hospital Charge Code |
H3020534
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
