|
HCHG GROWTH HORMONE 90
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
H3010686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
|
|
HCHG HALOPERIDOL (HALDOL) 90
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 80173
|
| Hospital Charge Code |
H3010692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: AlohaCare Medicaid |
$15.78
|
| Rate for Payer: AlohaCare Medicare |
$15.78
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$17.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.78
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$15.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.78
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.78
|
| Rate for Payer: University Health Alliance Commercial |
$37.63
|
|
|
HCHG HALOPERIDOL (HALDOL) 90
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 80173
|
| Hospital Charge Code |
H3010692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HCHG HAND (2 VIEWS)
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200424
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
HCHG HAND (2 VIEWS)
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200424
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HCHG HAND 2 VIEWS PORT
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$299.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$242.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
HCHG HAND 2 VIEWS PORT
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200430
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$461.72 |
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Health Management Network Commercial |
$404.60
|
| Rate for Payer: MDX Hawaii PPO |
$461.72
|
|
|
HCHG HAND MIN 3 VIEWS
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
H3200428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$292.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$62.59
|
|
|
HCHG HAND MIN 3 VIEWS
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
H3200428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$487.05 |
| Max. Negotiated Rate |
$555.81 |
| Rate for Payer: Cash Price |
$372.45
|
| Rate for Payer: Health Management Network Commercial |
$487.05
|
| Rate for Payer: MDX Hawaii PPO |
$555.81
|
|
|
HCHG HANGING DROP
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
H3060206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
|
|
HCHG HANGING DROP
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
H3060206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: AlohaCare Medicaid |
$5.82
|
| Rate for Payer: AlohaCare Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Devoted Health Medicare |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.82
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.82
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG HAPTOGLOBIN
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
H3010694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$206.61 |
| Rate for Payer: AlohaCare Medicaid |
$12.58
|
| Rate for Payer: AlohaCare Medicare |
$12.58
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Devoted Health Medicare |
$13.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.58
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: Humana Medicare |
$12.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.58
|
| Rate for Payer: MDX Hawaii PPO |
$206.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.58
|
| Rate for Payer: University Health Alliance Commercial |
$32.52
|
|
|
HCHG HAPTOGLOBIN
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
H3010694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$181.05 |
| Max. Negotiated Rate |
$206.61 |
| Rate for Payer: Cash Price |
$138.45
|
| Rate for Payer: Health Management Network Commercial |
$181.05
|
| Rate for Payer: MDX Hawaii PPO |
$206.61
|
|
|
HCHG HCG QUAL URINE
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
K3010049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: AlohaCare Medicaid |
$7.52
|
| Rate for Payer: AlohaCare Medicare |
$7.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$8.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$7.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.52
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.52
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HCHG HCG QUAL URINE
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
K3010049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
HCHG HCG QUANT TUMOR
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
H3010702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: AlohaCare Medicaid |
$15.05
|
| Rate for Payer: AlohaCare Medicare |
$15.05
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Devoted Health Medicare |
$16.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.05
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Humana Medicare |
$15.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.05
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.05
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HCHG HCG QUANT TUMOR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
H3010702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
|
|
HCHG HCG SO
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 84704
|
| Hospital Charge Code |
K3010062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
|
|
HCHG HCG SO
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 84704
|
| Hospital Charge Code |
K3010062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: AlohaCare Medicaid |
$15.29
|
| Rate for Payer: AlohaCare Medicare |
$15.29
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$16.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.29
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$15.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.29
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.29
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HCHG HCV GENOTYPING
|
Facility
|
IP
|
$3,322.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
H3020972
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2,823.70 |
| Max. Negotiated Rate |
$3,222.34 |
| Rate for Payer: Cash Price |
$2,159.30
|
| Rate for Payer: Health Management Network Commercial |
$2,823.70
|
| Rate for Payer: MDX Hawaii PPO |
$3,222.34
|
|
|
HCHG HCV GENOTYPING
|
Facility
|
OP
|
$3,322.00
|
|
|
Service Code
|
HCPCS 87902
|
| Hospital Charge Code |
H3020972
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$256.16 |
| Max. Negotiated Rate |
$3,222.34 |
| Rate for Payer: AlohaCare Medicaid |
$257.45
|
| Rate for Payer: AlohaCare Medicare |
$257.45
|
| Rate for Payer: Cash Price |
$2,159.30
|
| Rate for Payer: Cash Price |
$2,159.30
|
| Rate for Payer: Devoted Health Medicare |
$283.19
|
| 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 |
$257.45
|
| 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 |
$2,823.70
|
| Rate for Payer: Humana Medicare |
$257.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,092.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,694.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.45
|
| Rate for Payer: MDX Hawaii PPO |
$3,222.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$256.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.45
|
| Rate for Payer: University Health Alliance Commercial |
$665.43
|
|
|
HCHG HCV-RNA QUANT TAQMAN 90
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
H3060212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$447.10 |
| Max. Negotiated Rate |
$510.22 |
| Rate for Payer: Cash Price |
$341.90
|
| Rate for Payer: Health Management Network Commercial |
$447.10
|
| Rate for Payer: MDX Hawaii PPO |
$510.22
|
|
|
HCHG HCV-RNA QUANT TAQMAN 90
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
H3060212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$510.22 |
| Rate for Payer: AlohaCare Medicaid |
$42.84
|
| Rate for Payer: AlohaCare Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$341.90
|
| Rate for Payer: Cash Price |
$341.90
|
| Rate for Payer: Devoted Health Medicare |
$47.12
|
| 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 |
$42.84
|
| 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 |
$447.10
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$268.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.84
|
| Rate for Payer: MDX Hawaii PPO |
$510.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.84
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HCHG HCV RT-PCR QUANT PCR
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
H3060210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$510.22 |
| Rate for Payer: AlohaCare Medicaid |
$42.84
|
| Rate for Payer: AlohaCare Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$341.90
|
| Rate for Payer: Cash Price |
$341.90
|
| Rate for Payer: Devoted Health Medicare |
$47.12
|
| 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 |
$42.84
|
| 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 |
$447.10
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$268.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.84
|
| Rate for Payer: MDX Hawaii PPO |
$510.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.84
|
| Rate for Payer: University Health Alliance Commercial |
$110.72
|
|
|
HCHG HCV RT-PCR QUANT PCR
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
H3060210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$447.10 |
| Max. Negotiated Rate |
$510.22 |
| Rate for Payer: Cash Price |
$341.90
|
| Rate for Payer: Health Management Network Commercial |
$447.10
|
| Rate for Payer: MDX Hawaii PPO |
$510.22
|
|
