|
HCHG HIP UNILAT W/ OR W/O PELVIS 1 VIEW
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
H3200986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$427.77 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.12
|
| 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 |
$19.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$374.85
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$427.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$61.27
|
|
|
HCHG HIP UNILAT W/ OR W/O PELVIS 1 VIEW
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
H3200986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.85 |
| Max. Negotiated Rate |
$427.77 |
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Health Management Network Commercial |
$374.85
|
| Rate for Payer: MDX Hawaii PPO |
$427.77
|
|
|
HCHG HIP UNILAT W/ OR W/O PELVIS 2-3 VIEWS
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
H3200987
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$374.85 |
| Max. Negotiated Rate |
$427.77 |
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Health Management Network Commercial |
$374.85
|
| Rate for Payer: MDX Hawaii PPO |
$427.77
|
|
|
HCHG HIP UNILAT W/ OR W/O PELVIS 2-3 VIEWS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
H3200987
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$427.77 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.87
|
| 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 |
$28.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$374.85
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$427.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$86.21
|
|
|
HCHG HIP UNILAT W/ OR W/O PELVIS MIN 4 VIEWS
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
H3200988
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.86
|
| 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 |
$35.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$440.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$123.25
|
|
|
HCHG HIP UNILAT W/ OR W/O PELVIS MIN 4 VIEWS
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 73503
|
| Hospital Charge Code |
H3200988
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
|
HCHG HISTOPLASMA AB EA AB
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
H3020568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
|
|
HCHG HISTOPLASMA AB EA AB
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
H3020566
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: AlohaCare Medicaid |
$13.79
|
| Rate for Payer: AlohaCare Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Devoted Health Medicare |
$15.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.79
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$13.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.79
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.79
|
| Rate for Payer: University Health Alliance Commercial |
$32.30
|
|
|
HCHG HISTOPLASMA AB EA AB
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
H3020568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: AlohaCare Medicaid |
$13.79
|
| Rate for Payer: AlohaCare Medicare |
$13.79
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Devoted Health Medicare |
$15.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.48
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.79
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: Humana Medicare |
$13.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.79
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.79
|
| Rate for Payer: University Health Alliance Commercial |
$32.30
|
|
|
HCHG HISTOPLASMA AB EA AB
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
HCPCS 86698
|
| Hospital Charge Code |
H3020566
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Cash Price |
$105.30
|
| Rate for Payer: Health Management Network Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$157.14
|
|
|
HCHG HISTOPLASMA CAPSULT AG SO
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
K3060030
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$13.25
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.25
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG HISTOPLASMA CAPSULT AG SO
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
K3060030
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
HCHG HISTOPLASMA GALACTOMANNAN AG, URINE - 90
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
H3021019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: AlohaCare Medicaid |
$13.25
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.25
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG HISTOPLASMA GALACTOMANNAN AG, URINE - 90
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
HCPCS 87385
|
| Hospital Charge Code |
H3021019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$176.80 |
| Max. Negotiated Rate |
$201.76 |
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Management Network Commercial |
$176.80
|
| Rate for Payer: MDX Hawaii PPO |
$201.76
|
|
|
HCHG HIV 1/2 AB RAPID, REFLEX
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
H3020923
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: AlohaCare Medicaid |
$13.71
|
| Rate for Payer: AlohaCare Medicare |
$13.71
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$15.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.71
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$13.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.71
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.71
|
| Rate for Payer: University Health Alliance Commercial |
$35.46
|
|
|
HCHG HIV 1/2 AB RAPID, REFLEX
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
H3020923
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
HCHG HIV-1/2 AG/AB WITH REFLEX - 90
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 87390
|
| Hospital Charge Code |
H3021052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
|
|
HCHG HIV-1/2 AG/AB WITH REFLEX - 90
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
H3021050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
HCHG HIV-1/2 AG/AB WITH REFLEX - 90
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 87390
|
| Hospital Charge Code |
H3021052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.92 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: AlohaCare Medicaid |
$24.06
|
| Rate for Payer: AlohaCare Medicare |
$24.06
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Devoted Health Medicare |
$26.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.06
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Humana Medicare |
$24.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.06
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.06
|
| Rate for Payer: University Health Alliance Commercial |
$39.13
|
|
|
HCHG HIV-1/2 AG/AB WITH REFLEX - 90
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 86702
|
| Hospital Charge Code |
H3021051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
HCHG HIV-1/2 AG/AB WITH REFLEX - 90
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
H3021050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$8.89
|
| Rate for Payer: AlohaCare Medicare |
$8.89
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Devoted Health Medicare |
$9.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.89
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$8.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.89
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.89
|
| Rate for Payer: University Health Alliance Commercial |
$22.96
|
|
|
HCHG HIV-1/2 AG/AB WITH REFLEX - 90
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 86702
|
| Hospital Charge Code |
H3021051
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: AlohaCare Medicaid |
$13.52
|
| Rate for Payer: AlohaCare Medicare |
$13.52
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$14.87
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.52
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.52
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.52
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.52
|
| Rate for Payer: University Health Alliance Commercial |
$34.93
|
|
|
HCHG HIV 1 AG W HIV 1/2 ABS
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
K3060031
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
| Rate for Payer: MDX Hawaii PPO |
$331.74
|
|
|
HCHG HIV 1 AG W HIV 1/2 ABS
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
K3060031
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: AlohaCare Medicaid |
$24.08
|
| Rate for Payer: AlohaCare Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Devoted Health Medicare |
$26.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.08
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$215.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.08
|
| Rate for Payer: MDX Hawaii PPO |
$331.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.08
|
| Rate for Payer: University Health Alliance Commercial |
$63.12
|
|
|
HCHG HIV-1 AG W/ HIV-1 & HIV-2 AB WITH REFLEX
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
H3100176
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: AlohaCare Medicaid |
$24.08
|
| Rate for Payer: AlohaCare Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: Devoted Health Medicare |
$26.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$30.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.08
|
| Rate for Payer: Health Management Network Commercial |
$290.70
|
| Rate for Payer: Humana Medicare |
$24.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$215.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$174.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.08
|
| Rate for Payer: MDX Hawaii PPO |
$331.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.08
|
| Rate for Payer: University Health Alliance Commercial |
$63.12
|
|
