|
HCHG MICROALBUMIN URINE
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
H3010904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: AlohaCare Medicaid |
$5.78
|
| Rate for Payer: AlohaCare Medicare |
$5.78
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$6.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.78
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.78
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.78
|
| Rate for Payer: University Health Alliance Commercial |
$14.97
|
|
|
HCHG MICROALBUMIN URINE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 82043
|
| Hospital Charge Code |
H3010904
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG MICROBIAL ID AMP PROB SO
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
K3060042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$500.65 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
|
|
HCHG MICROBIAL ID AMP PROB SO
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
K3060042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$571.33 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Cash Price |
$382.85
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$500.65
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$571.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG MICROSPORIDIA
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
H3060679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG MICROSPORIDIA
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
H3060679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.99
|
| Rate for Payer: AlohaCare Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$6.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.99
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.99
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.99
|
| Rate for Payer: University Health Alliance Commercial |
$15.48
|
|
|
HCHG MITOCHONDRIAL AB
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
H3021046
|
|
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 MITOCHONDRIAL AB
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
H3021046
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$166.84 |
| Rate for Payer: AlohaCare Medicaid |
$25.45
|
| Rate for Payer: AlohaCare Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Cash Price |
$111.80
|
| Rate for Payer: Devoted Health Medicare |
$28.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$146.20
|
| Rate for Payer: Humana Medicare |
$25.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.45
|
| Rate for Payer: MDX Hawaii PPO |
$166.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.45
|
| Rate for Payer: University Health Alliance Commercial |
$125.37
|
|
|
HCHG MITOCHONDRIAL ANTIBODY
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
H3011527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HCHG MITOCHONDRIAL ANTIBODY
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
H3011527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$12.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.53
|
| Rate for Payer: University Health Alliance Commercial |
$29.82
|
|
|
HCHG MI W PYP SPECT
|
Facility
|
IP
|
$2,860.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
H3410226
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,431.00 |
| Max. Negotiated Rate |
$2,774.20 |
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Health Management Network Commercial |
$2,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,774.20
|
|
|
HCHG MI W PYP SPECT
|
Facility
|
OP
|
$2,860.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
H3410226
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.26 |
| Max. Negotiated Rate |
$2,774.20 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$172.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$186.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,431.00
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,458.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,774.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$172.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$547.27
|
|
|
HCHG MLH1 HYPERMETHYLATION - 90
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
HCPCS 81288
|
| Hospital Charge Code |
H3100200
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$847.45 |
| Max. Negotiated Rate |
$967.09 |
| Rate for Payer: Cash Price |
$648.05
|
| Rate for Payer: Health Management Network Commercial |
$847.45
|
| Rate for Payer: MDX Hawaii PPO |
$967.09
|
|
|
HCHG MLH1 HYPERMETHYLATION - 90
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
HCPCS 81288
|
| Hospital Charge Code |
H3100200
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$144.24 |
| Max. Negotiated Rate |
$967.09 |
| Rate for Payer: AlohaCare Medicaid |
$192.32
|
| Rate for Payer: AlohaCare Medicare |
$192.32
|
| Rate for Payer: Cash Price |
$648.05
|
| Rate for Payer: Cash Price |
$648.05
|
| Rate for Payer: Devoted Health Medicare |
$211.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$159.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$240.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$192.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$159.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$192.32
|
| Rate for Payer: Health Management Network Commercial |
$847.45
|
| Rate for Payer: Humana Medicare |
$192.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$628.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$508.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.32
|
| Rate for Payer: MDX Hawaii PPO |
$967.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$211.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$192.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$144.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$192.32
|
| Rate for Payer: University Health Alliance Commercial |
$726.71
|
|
|
HCHG MODIFIED TRAUMA ACTIVATION W/O CC
|
Facility
|
IP
|
$4,086.00
|
|
| Hospital Charge Code |
K6830002
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$3,473.10 |
| Max. Negotiated Rate |
$3,963.42 |
| Rate for Payer: Cash Price |
$2,655.90
|
| Rate for Payer: Health Management Network Commercial |
$3,473.10
|
| Rate for Payer: MDX Hawaii PPO |
$3,963.42
|
|
|
HCHG MODIFIED TRAUMA ACTIVATION W/O CC
|
Facility
|
OP
|
$4,086.00
|
|
| Hospital Charge Code |
K6830002
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$2,083.86 |
| Max. Negotiated Rate |
$3,963.42 |
| Rate for Payer: Cash Price |
$2,655.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,881.70
|
| Rate for Payer: Health Management Network Commercial |
$3,473.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,574.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,083.86
|
| Rate for Payer: MDX Hawaii PPO |
$3,963.42
|
| Rate for Payer: University Health Alliance Commercial |
$2,978.29
|
|
|
HCHG MOLD IDENTIFICATION
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
H3060290
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$10.32
|
| Rate for Payer: AlohaCare Medicare |
$10.32
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$11.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$10.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.32
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.32
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
HCHG MOLD IDENTIFICATION
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
H3060290
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
HCHG MOLEC IGH HEAVY CHAIN - 90
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
H3100193
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$675.75 |
| Max. Negotiated Rate |
$771.15 |
| Rate for Payer: Cash Price |
$516.75
|
| Rate for Payer: Health Management Network Commercial |
$675.75
|
| Rate for Payer: MDX Hawaii PPO |
$771.15
|
|
|
HCHG MOLEC IGH HEAVY CHAIN - 90
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 81261
|
| Hospital Charge Code |
H3100193
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$771.15 |
| Rate for Payer: AlohaCare Medicaid |
$197.99
|
| Rate for Payer: AlohaCare Medicare |
$197.99
|
| Rate for Payer: Cash Price |
$516.75
|
| Rate for Payer: Cash Price |
$516.75
|
| Rate for Payer: Devoted Health Medicare |
$217.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$247.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$265.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$197.99
|
| Rate for Payer: Health Management Network Commercial |
$675.75
|
| Rate for Payer: Humana Medicare |
$197.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$500.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.99
|
| Rate for Payer: MDX Hawaii PPO |
$771.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.99
|
| Rate for Payer: University Health Alliance Commercial |
$579.48
|
|
|
HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID CHLAMYDIA
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060668
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$373.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID CHLAMYDIA
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
H3060668
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$504.05 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
|
|
HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID GONORRHEA
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
H3060669
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$373.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG MOLEC INFECT AGENT DETECTION BY NUC ACID GONORRHEA
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
H3060669
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$504.05 |
| Max. Negotiated Rate |
$575.21 |
| Rate for Payer: Cash Price |
$385.45
|
| Rate for Payer: Health Management Network Commercial |
$504.05
|
| Rate for Payer: MDX Hawaii PPO |
$575.21
|
|
|
HCHG MOLECULAR CYTOGEN, DNA PROBE EA
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 88271
|
| Hospital Charge Code |
H3110291
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: AlohaCare Medicaid |
$21.42
|
| Rate for Payer: AlohaCare Medicare |
$21.42
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Devoted Health Medicare |
$23.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.42
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.42
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Humana Medicare |
$21.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.42
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.42
|
| Rate for Payer: University Health Alliance Commercial |
$55.37
|
|
