|
HCHG HEP B CORE AB TOT
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
H3020530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG HEP B CORE AB TOT
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
H3020530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG HEP B DNA QUANT 90
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
H3060218
|
|
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 HEP B DNA QUANT 90
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 87517
|
| Hospital Charge Code |
H3060218
|
|
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 HEP BE AB
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
H3020538
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
HCHG HEP BE AB
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 86707
|
| Hospital Charge Code |
H3020538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.57 |
| 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 |
$15.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| 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 |
$15.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.90
|
|
|
HCHG HEP BE AG
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
H3060226
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.53 |
| 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 |
$15.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| 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 |
$15.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.79
|
|
|
HCHG HEP BE AG
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 87350
|
| Hospital Charge Code |
H3060226
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
HCHG HEP B SURF AB
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
H3020532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| 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 |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| 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 |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HCHG HEP B SURF AB
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
H3020532
|
|
Hospital Revenue Code
|
302
|
| 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 HEP B SURF AG
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
H3060222
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$78.21 |
| Rate for Payer: AlohaCare Medicaid |
$39.50
|
| Rate for Payer: AlohaCare Medicare |
$71.10
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Devoted Health Medicare |
$78.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$71.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.33
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Humana Medicare |
$71.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$40.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$71.10
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$71.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$71.10
|
| Rate for Payer: University Health Alliance Commercial |
$26.70
|
|
|
HCHG HEP B SURF AG
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
H3060222
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$67.15 |
| Max. Negotiated Rate |
$76.63 |
| Rate for Payer: Cash Price |
$51.35
|
| Rate for Payer: Health Management Network Commercial |
$67.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.10
|
| Rate for Payer: MDX Hawaii PPO |
$76.63
|
|
|
HCHG HEP B SURF AG CONF
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
H3060224
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$75.24 |
| Rate for Payer: AlohaCare Medicaid |
$38.00
|
| Rate for Payer: AlohaCare Medicare |
$68.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Devoted Health Medicare |
$75.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.33
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Humana Medicare |
$68.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.40
|
| Rate for Payer: University Health Alliance Commercial |
$26.70
|
|
|
HCHG HEP B SURF AG CONF
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 87341
|
| Hospital Charge Code |
H3060224
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Cash Price |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
|
|
HCHG HEP C AB
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
H3020540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$204.67 |
| Rate for Payer: Cash Price |
$137.15
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$189.90
|
| Rate for Payer: MDX Hawaii PPO |
$204.67
|
|
|
HCHG HEP C AB
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
H3020540
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$208.89 |
| Rate for Payer: AlohaCare Medicaid |
$105.50
|
| Rate for Payer: AlohaCare Medicare |
$189.90
|
| Rate for Payer: Cash Price |
$137.15
|
| Rate for Payer: Cash Price |
$137.15
|
| Rate for Payer: Devoted Health Medicare |
$208.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.27
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Humana Medicare |
$189.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$189.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$189.90
|
| Rate for Payer: MDX Hawaii PPO |
$204.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.90
|
| Rate for Payer: University Health Alliance Commercial |
$36.89
|
|
|
HCHG HEP E VIRUS IGG
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
H3020546
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG HEP E VIRUS IGG
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
H3020546
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG HEP E VIRUS IGM
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
H3020548
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG HEP E VIRUS IGM
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
H3020548
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG HER2 ISH MORPH MULTIPLEX
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
HCPCS 88374
|
| Hospital Charge Code |
H3120349
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$1,106.82 |
| Rate for Payer: AlohaCare Medicaid |
$559.00
|
| Rate for Payer: AlohaCare Medicare |
$1,006.20
|
| Rate for Payer: Cash Price |
$726.70
|
| Rate for Payer: Cash Price |
$726.70
|
| Rate for Payer: Devoted Health Medicare |
$1,106.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,006.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$160.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$950.30
|
| Rate for Payer: Humana Medicare |
$1,006.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,006.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$570.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,006.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,084.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,006.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,006.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$195.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,006.20
|
| Rate for Payer: University Health Alliance Commercial |
$736.61
|
|
|
HCHG HER2 ISH MORPH MULTIPLEX
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
HCPCS 88374
|
| Hospital Charge Code |
H3120349
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$950.30 |
| Max. Negotiated Rate |
$1,084.46 |
| Rate for Payer: Cash Price |
$726.70
|
| Rate for Payer: Health Management Network Commercial |
$950.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,006.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,084.46
|
|
|
HCHG HERPES SIMPLEX TYPE 1 AB, IGG
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
H3020919
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| 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 |
$18.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.19
|
| 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 |
$18.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$34.10
|
|
|
HCHG HERPES SIMPLEX TYPE 1 AB, IGG
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
H3020919
|
|
Hospital Revenue Code
|
302
|
| 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 HERPES SIMPLEX TYPE 2 AB, IGG
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 86696
|
| Hospital Charge Code |
H3020920
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$140.58 |
| Rate for Payer: AlohaCare Medicaid |
$71.00
|
| Rate for Payer: AlohaCare Medicare |
$127.80
|
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Cash Price |
$92.30
|
| Rate for Payer: Devoted Health Medicare |
$140.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.35
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$127.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.80
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.80
|
| Rate for Payer: University Health Alliance Commercial |
$50.04
|
|
