|
HCHG ALPHA FETOPROTEIN CSF SO
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
K3020005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$248.32 |
| Rate for Payer: AlohaCare Medicaid |
$20.81
|
| Rate for Payer: AlohaCare Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Devoted Health Medicare |
$22.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$217.60
|
| Rate for Payer: Humana Medicare |
$20.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.81
|
| Rate for Payer: MDX Hawaii PPO |
$248.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.81
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG ALPHA FETOPROTEIN SERUM
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
K3010022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$200.79 |
| Rate for Payer: AlohaCare Medicaid |
$16.77
|
| Rate for Payer: AlohaCare Medicare |
$16.77
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Devoted Health Medicare |
$18.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.77
|
| Rate for Payer: Health Management Network Commercial |
$175.95
|
| Rate for Payer: Humana Medicare |
$16.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.77
|
| Rate for Payer: MDX Hawaii PPO |
$200.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.77
|
| Rate for Payer: University Health Alliance Commercial |
$43.36
|
|
|
HCHG ALPHA FETOPROTEIN SERUM
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
K3010022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.95 |
| Max. Negotiated Rate |
$200.79 |
| Rate for Payer: Cash Price |
$134.55
|
| Rate for Payer: Health Management Network Commercial |
$175.95
|
| Rate for Payer: MDX Hawaii PPO |
$200.79
|
|
|
HCHG ALPHA-GLOBIN COMMON MUTATION - 90
|
Facility
|
IP
|
$902.00
|
|
|
Service Code
|
HCPCS 81257
|
| Hospital Charge Code |
H3100159
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$766.70 |
| Max. Negotiated Rate |
$874.94 |
| Rate for Payer: Cash Price |
$586.30
|
| Rate for Payer: Health Management Network Commercial |
$766.70
|
| Rate for Payer: MDX Hawaii PPO |
$874.94
|
|
|
HCHG ALPHA-GLOBIN COMMON MUTATION - 90
|
Facility
|
OP
|
$902.00
|
|
|
Service Code
|
HCPCS 81257
|
| Hospital Charge Code |
H3100159
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$874.94 |
| Rate for Payer: AlohaCare Medicaid |
$102.26
|
| Rate for Payer: AlohaCare Medicare |
$102.26
|
| Rate for Payer: Cash Price |
$586.30
|
| Rate for Payer: Cash Price |
$586.30
|
| Rate for Payer: Devoted Health Medicare |
$112.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$178.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$178.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.26
|
| Rate for Payer: Health Management Network Commercial |
$766.70
|
| Rate for Payer: Humana Medicare |
$102.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$568.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$460.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.26
|
| Rate for Payer: MDX Hawaii PPO |
$874.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.26
|
| Rate for Payer: University Health Alliance Commercial |
$338.96
|
|
|
HCHG AMIKACIN LEVEL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
H3010174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: AlohaCare Medicaid |
$15.08
|
| Rate for Payer: AlohaCare Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Devoted Health Medicare |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.08
|
| Rate for Payer: MDX Hawaii PPO |
$190.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.08
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
|
HCHG AMIKACIN LEVEL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
H3010174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Cash Price |
$127.40
|
| Rate for Payer: Health Management Network Commercial |
$166.60
|
| Rate for Payer: MDX Hawaii PPO |
$190.12
|
|
|
HCHG AMINOLEVULINIC ACID (ALA)
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82135
|
| Hospital Charge Code |
H3010186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$16.45
|
| Rate for Payer: AlohaCare Medicare |
$16.45
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$18.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.45
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$16.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$71.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.45
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.45
|
| Rate for Payer: University Health Alliance Commercial |
$42.55
|
|
|
HCHG AMINOLEVULINIC ACID (ALA)
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82135
|
| Hospital Charge Code |
H3010186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
HCHG AMMONIA
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
H3010192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$214.37 |
| Rate for Payer: AlohaCare Medicaid |
$14.57
|
| Rate for Payer: AlohaCare Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$143.65
|
| Rate for Payer: Cash Price |
$143.65
|
| Rate for Payer: Devoted Health Medicare |
$16.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network Commercial |
$187.85
|
| Rate for Payer: Humana Medicare |
$14.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.57
|
| Rate for Payer: MDX Hawaii PPO |
$214.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.57
|
| Rate for Payer: University Health Alliance Commercial |
$37.67
|
|
|
HCHG AMMONIA
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
H3010192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$214.37 |
| Rate for Payer: Cash Price |
$143.65
|
| Rate for Payer: Health Management Network Commercial |
$187.85
|
| Rate for Payer: MDX Hawaii PPO |
$214.37
|
|
|
HCHG AMOEBIC AB 90
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
H3020228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: AlohaCare Medicaid |
$12.39
|
| Rate for Payer: AlohaCare Medicare |
$12.39
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Devoted Health Medicare |
$13.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.39
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.39
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.39
|
| Rate for Payer: University Health Alliance Commercial |
$32.04
|
|
|
HCHG AMOEBIC AB 90
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
H3020228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HCHG AMPUTATION OF FINGER OR THUMB
|
Facility
|
OP
|
$8,369.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
H4500110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$8,117.93 |
| Rate for Payer: AlohaCare Medicaid |
$3,865.36
|
| Rate for Payer: AlohaCare Medicare |
$3,865.36
|
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Devoted Health Medicare |
$4,251.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6,183.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,865.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$700.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,950.55
|
| Rate for Payer: Health Management Network Commercial |
$7,113.65
|
| Rate for Payer: Humana Medicare |
$3,865.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,272.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,865.36
|
| Rate for Payer: MDX Hawaii PPO |
$8,117.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,251.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,865.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,865.36
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG AMPUTATION OF FINGER OR THUMB
|
Facility
|
IP
|
$8,369.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
H4500110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7,113.65 |
| Max. Negotiated Rate |
$8,117.93 |
| Rate for Payer: Cash Price |
$5,439.85
|
| Rate for Payer: Health Management Network Commercial |
$7,113.65
|
| Rate for Payer: MDX Hawaii PPO |
$8,117.93
|
|
|
HCHG AMYLASE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
H3010218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: AlohaCare Medicaid |
$6.48
|
| Rate for Payer: AlohaCare Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$7.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.48
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.48
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
|
|
HCHG AMYLASE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
H3010218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
HCHG AMYLASE BODY FLD
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
H3010220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: AlohaCare Medicaid |
$6.48
|
| Rate for Payer: AlohaCare Medicare |
$6.48
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$7.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.48
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.48
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
|
|
HCHG AMYLASE BODY FLD
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
H3010220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
HCHG ANA-BODY FLD
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
HCHG ANA-BODY FLD
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 86038
|
| Hospital Charge Code |
H3020230
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$12.09
|
| Rate for Payer: AlohaCare Medicare |
$12.09
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$13.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.09
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$12.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.09
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.09
|
| Rate for Payer: University Health Alliance Commercial |
$31.25
|
|
|
HCHG ANA TITER
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
K3020003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$166.84 |
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Health Management Network Commercial |
$146.20
|
| Rate for Payer: MDX Hawaii PPO |
$166.84
|
|
|
HCHG ANA TITER
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 86039
|
| Hospital Charge Code |
K3020003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$166.84 |
| Rate for Payer: AlohaCare Medicaid |
$11.16
|
| Rate for Payer: AlohaCare Medicare |
$11.16
|
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Devoted Health Medicare |
$12.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.16
|
| Rate for Payer: Health Management Network Commercial |
$146.20
|
| Rate for Payer: Humana Medicare |
$11.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.16
|
| Rate for Payer: MDX Hawaii PPO |
$166.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.16
|
| Rate for Payer: University Health Alliance Commercial |
$28.86
|
|
|
HCHG ANCA SCREEN, REFLEX TO TITER
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
H3021044
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| 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 |
$12.05
|
| 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 |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$67.06
|
|
|
HCHG ANCA SCREEN, REFLEX TO TITER
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
H3021044
|
|
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: MDX Hawaii PPO |
$89.24
|
|
