|
HCHG JAK2 EXON 12 ANALYSIS SOO
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
HCPCS 81279
|
| Hospital Charge Code |
K3100004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$1,570.14 |
| Rate for Payer: AlohaCare Medicaid |
$793.00
|
| Rate for Payer: AlohaCare Medicare |
$1,427.40
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Devoted Health Medicare |
$1,570.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$185.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,427.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$185.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.20
|
| Rate for Payer: Health Management Network Commercial |
$1,348.10
|
| Rate for Payer: Humana Medicare |
$1,427.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,427.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,427.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,538.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,427.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,427.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,427.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,156.04
|
|
|
HCHG JAK2 EXON 12 ANALYSIS SOO
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
HCPCS 81279
|
| Hospital Charge Code |
K3100004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,348.10 |
| Max. Negotiated Rate |
$1,538.42 |
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Health Management Network Commercial |
$1,348.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,427.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,538.42
|
|
|
HCHG JAK2 EXON 12 MUTATION ANALYSIS
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
HCPCS 81279
|
| Hospital Charge Code |
H3100241
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,348.10 |
| Max. Negotiated Rate |
$1,538.42 |
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Health Management Network Commercial |
$1,348.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,427.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,538.42
|
|
|
HCHG JAK2 EXON 12 MUTATION ANALYSIS
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
HCPCS 81279
|
| Hospital Charge Code |
H3100241
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$1,570.14 |
| Rate for Payer: AlohaCare Medicaid |
$793.00
|
| Rate for Payer: AlohaCare Medicare |
$1,427.40
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Devoted Health Medicare |
$1,570.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$185.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$231.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,427.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$185.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.20
|
| Rate for Payer: Health Management Network Commercial |
$1,348.10
|
| Rate for Payer: Humana Medicare |
$1,427.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,427.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$808.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,427.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,538.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,427.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,427.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,427.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,156.04
|
|
|
HCHG JAK2V617F MUTATION ANALYSIS
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
H3100156
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$531.63 |
| Rate for Payer: AlohaCare Medicaid |
$268.50
|
| Rate for Payer: AlohaCare Medicare |
$483.30
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Devoted Health Medicare |
$531.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.66
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Humana Medicare |
$483.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$483.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.30
|
| Rate for Payer: University Health Alliance Commercial |
$230.79
|
|
|
HCHG JAK2V617F MUTATION ANALYSIS
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
H3100156
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
|
|
HCHG JAK2 V617F RF CALR/MPL SO
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
K3100003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$531.63 |
| Rate for Payer: AlohaCare Medicaid |
$268.50
|
| Rate for Payer: AlohaCare Medicare |
$483.30
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Devoted Health Medicare |
$531.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.66
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Humana Medicare |
$483.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$483.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.30
|
| Rate for Payer: University Health Alliance Commercial |
$230.79
|
|
|
HCHG JAK2 V617F RF CALR/MPL SO
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
K3100003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
|
|
HCHG JAK2 V617F RF EXON 12 SO
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
K3100002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$456.45 |
| Max. Negotiated Rate |
$520.89 |
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
|
|
HCHG JAK2 V617F RF EXON 12 SO
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
K3100002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$531.63 |
| Rate for Payer: AlohaCare Medicaid |
$268.50
|
| Rate for Payer: AlohaCare Medicare |
$483.30
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Cash Price |
$349.05
|
| Rate for Payer: Devoted Health Medicare |
$531.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$483.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.66
|
| Rate for Payer: Health Management Network Commercial |
$456.45
|
| Rate for Payer: Humana Medicare |
$483.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$483.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$273.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$483.30
|
| Rate for Payer: MDX Hawaii PPO |
$520.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$483.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$483.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$483.30
|
| Rate for Payer: University Health Alliance Commercial |
$230.79
|
|
|
HCHG JO-1 AB
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020626
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| 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 |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| 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 |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.70
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
HCHG JO-1 AB
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
H3020626
|
|
Hospital Revenue Code
|
302
|
| 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 KAPPA AND LAMBDA LIGHT CHAINS, FREE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
H3011736
|
|
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 KAPPA AND LAMBDA LIGHT CHAINS, FREE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
H3011736
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| 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 |
$10.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$94.03
|
|
|
HCHG KAPPA LT CHAIN QUANT SERUM
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$102.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.15
|
|
|
HCHG KAPPA LT CHAIN QUANT SERUM
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011549
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HCHG KAPPA LT CHAIN QUANT U
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011337
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$102.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.60
|
| Rate for Payer: University Health Alliance Commercial |
$35.15
|
|
|
HCHG KAPPA LT CHAIN QUANT U
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
H3011337
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HCHG KLEIHAUER-BETKE (FETADEX) 90
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
H3050178
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$53.10
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$58.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.73
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Humana Medicare |
$53.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.10
|
| Rate for Payer: University Health Alliance Commercial |
$20.00
|
|
|
HCHG KLEIHAUER-BETKE (FETADEX) 90
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 85460
|
| Hospital Charge Code |
H3050178
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
|
|
HCHG KNEE (1-2) VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
|
|
HCHG KNEE (1-2) VIEWS
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$507.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$558.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$507.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
HCHG KNEE 2 VIEWS PORT
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200516
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
|
|
HCHG KNEE 2 VIEWS PORT
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73560
|
| Hospital Charge Code |
H3200516
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$507.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$558.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$507.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$58.59
|
|
|
HCHG KNEE 3 VIEWS
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
H3200520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$597.96 |
| Rate for Payer: AlohaCare Medicaid |
$302.00
|
| Rate for Payer: AlohaCare Medicare |
$543.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Cash Price |
$392.60
|
| Rate for Payer: Devoted Health Medicare |
$597.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$543.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$513.40
|
| Rate for Payer: Humana Medicare |
$543.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$543.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$308.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$543.60
|
| Rate for Payer: MDX Hawaii PPO |
$585.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$543.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$543.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$543.60
|
| Rate for Payer: University Health Alliance Commercial |
$68.32
|
|
