|
HCHG TISS EXAM CX/LG MULT LVL V
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
H3120284
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$1,089.31 |
| Rate for Payer: AlohaCare Medicaid |
$423.45
|
| Rate for Payer: AlohaCare Medicare |
$423.45
|
| Rate for Payer: Cash Price |
$729.95
|
| Rate for Payer: Cash Price |
$729.95
|
| Rate for Payer: Devoted Health Medicare |
$465.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$118.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$529.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$423.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.45
|
| Rate for Payer: Health Management Network Commercial |
$954.55
|
| Rate for Payer: Humana Medicare |
$423.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$707.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$572.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$423.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,089.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$423.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$423.45
|
| Rate for Payer: University Health Alliance Commercial |
$408.52
|
|
|
HCHG TISS EXAM RAD SPEC/CMPRH LVL VI
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
H3120280
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$1,430.55 |
| Max. Negotiated Rate |
$1,632.51 |
| Rate for Payer: Cash Price |
$1,093.95
|
| Rate for Payer: Health Management Network Commercial |
$1,430.55
|
| Rate for Payer: MDX Hawaii PPO |
$1,632.51
|
|
|
HCHG TISS EXAM RAD SPEC/CMPRH LVL VI
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
H3120280
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$1,632.51 |
| Rate for Payer: AlohaCare Medicaid |
$951.79
|
| Rate for Payer: AlohaCare Medicare |
$951.79
|
| Rate for Payer: Cash Price |
$1,093.95
|
| Rate for Payer: Cash Price |
$1,093.95
|
| Rate for Payer: Devoted Health Medicare |
$1,046.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,189.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$951.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$951.79
|
| Rate for Payer: Health Management Network Commercial |
$1,430.55
|
| Rate for Payer: Humana Medicare |
$951.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,060.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$858.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$951.79
|
| Rate for Payer: MDX Hawaii PPO |
$1,632.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,046.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$951.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$951.79
|
| Rate for Payer: University Health Alliance Commercial |
$604.38
|
|
|
HCHG TISS EXAM SM UNCOMP LVL III
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
H3120288
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
|
|
HCHG TISS EXAM SM UNCOMP LVL III
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
H3120288
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: AlohaCare Medicaid |
$61.56
|
| Rate for Payer: AlohaCare Medicare |
$61.56
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Devoted Health Medicare |
$67.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$38.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$76.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Humana Medicare |
$61.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.56
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.56
|
| Rate for Payer: University Health Alliance Commercial |
$126.30
|
|
|
HCHG TISS GROS/MICRO ID REC LVLII
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
H3120290
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$246.50 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Health Management Network Commercial |
$246.50
|
| Rate for Payer: MDX Hawaii PPO |
$281.30
|
|
|
HCHG TISS GROS/MICRO ID REC LVLII
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
H3120290
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: AlohaCare Medicaid |
$44.12
|
| Rate for Payer: AlohaCare Medicare |
$44.12
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Devoted Health Medicare |
$48.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.12
|
| Rate for Payer: Health Management Network Commercial |
$246.50
|
| Rate for Payer: Humana Medicare |
$44.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$182.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.12
|
| Rate for Payer: MDX Hawaii PPO |
$281.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.12
|
| Rate for Payer: University Health Alliance Commercial |
$102.23
|
|
|
HCHG TISS GROSS EXAM ONLY LVLI
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
H3120292
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$236.68 |
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: MDX Hawaii PPO |
$236.68
|
|
|
HCHG TISS GROSS EXAM ONLY LVLI
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
H3120292
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$236.68 |
| Rate for Payer: AlohaCare Medicaid |
$34.17
|
| Rate for Payer: AlohaCare Medicare |
$34.17
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Cash Price |
$158.60
|
| Rate for Payer: Devoted Health Medicare |
$37.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$34.17
|
| Rate for Payer: Health Management Network Commercial |
$207.40
|
| Rate for Payer: Humana Medicare |
$34.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.17
|
| Rate for Payer: MDX Hawaii PPO |
$236.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.17
|
| Rate for Payer: University Health Alliance Commercial |
$46.82
|
|
|
HCHG TISSUE CULT
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
H3060494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$311.37 |
| Rate for Payer: AlohaCare Medicaid |
$26.07
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$208.65
|
| Rate for Payer: Cash Price |
$208.65
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$272.85
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.07
|
| Rate for Payer: MDX Hawaii PPO |
$311.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
| Rate for Payer: University Health Alliance Commercial |
$67.38
|
|
|
HCHG TISSUE CULT
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
H3060494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$272.85 |
| Max. Negotiated Rate |
$311.37 |
| Rate for Payer: Cash Price |
$208.65
|
| Rate for Payer: Health Management Network Commercial |
$272.85
|
| Rate for Payer: MDX Hawaii PPO |
$311.37
|
|
|
HCHG TISSUE CULT NEOPLAS BM/BD 90
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3100142
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,055.70 |
| Max. Negotiated Rate |
$1,204.74 |
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Health Management Network Commercial |
$1,055.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,204.74
|
|
|
HCHG TISSUE CULT NEOPLAS BM/BD 90
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3100142
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.68 |
| Max. Negotiated Rate |
$1,204.74 |
| Rate for Payer: AlohaCare Medicaid |
$143.75
|
| Rate for Payer: AlohaCare Medicare |
$143.75
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Devoted Health Medicare |
$158.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$179.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.75
|
| Rate for Payer: Health Management Network Commercial |
$1,055.70
|
| Rate for Payer: Humana Medicare |
$143.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$633.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,204.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.75
|
| Rate for Payer: University Health Alliance Commercial |
$326.47
|
|
|
HCHG TISSUE CULT NEOPLASM BM/BLD
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3110292
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$125.68 |
| Max. Negotiated Rate |
$1,204.74 |
| Rate for Payer: AlohaCare Medicaid |
$143.75
|
| Rate for Payer: AlohaCare Medicare |
$143.75
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Devoted Health Medicare |
$158.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$125.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$179.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$143.75
|
| Rate for Payer: Health Management Network Commercial |
$1,055.70
|
| Rate for Payer: Humana Medicare |
$143.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$782.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$633.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.75
|
| Rate for Payer: MDX Hawaii PPO |
$1,204.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.75
|
| Rate for Payer: University Health Alliance Commercial |
$326.47
|
|
|
HCHG TISSUE CULT NEOPLASM BM/BLD
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 88237
|
| Hospital Charge Code |
H3110292
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$1,055.70 |
| Max. Negotiated Rate |
$1,204.74 |
| Rate for Payer: Cash Price |
$807.30
|
| Rate for Payer: Health Management Network Commercial |
$1,055.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,204.74
|
|
|
HCHG TISSUE(SPECIMEN) XRAY
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,469.25 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
|
|
HCHG TISSUE(SPECIMEN) XRAY
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 76098
|
| Hospital Charge Code |
H3200792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$2,817.85 |
| Rate for Payer: AlohaCare Medicaid |
$645.50
|
| Rate for Payer: AlohaCare Medicare |
$645.50
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Cash Price |
$1,888.25
|
| Rate for Payer: Devoted Health Medicare |
$710.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$806.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$645.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$645.50
|
| Rate for Payer: Health Management Network Commercial |
$2,469.25
|
| Rate for Payer: Humana Medicare |
$645.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,830.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,481.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$645.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,817.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$710.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$645.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$645.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.66
|
|
|
HCHG TISSUE TRANSGLUTAMINASE AB
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
H3021040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| 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 |
$126.65
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.53
|
| Rate for Payer: University Health Alliance Commercial |
$108.61
|
|
|
HCHG TISSUE TRANSGLUTAMINASE AB
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
H3021040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS 90
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
H3021056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS 90
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86364
|
| Hospital Charge Code |
H3021056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| 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 |
$126.65
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.53
|
| Rate for Payer: University Health Alliance Commercial |
$108.61
|
|
|
HCHG TITER, EACH ANTIBODY - 90
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
H3021064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$105.95
|
| 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 |
$138.55
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$31.15
|
|
|
HCHG TITER, EACH ANTIBODY - 90
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
H3021064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
HCHG TM JOINTS BIL
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
H3200794
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: AlohaCare Medicaid |
$102.81
|
| Rate for Payer: AlohaCare Medicare |
$102.81
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Devoted Health Medicare |
$113.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.83
|
| 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 |
$30.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: Humana Medicare |
$102.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.81
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.81
|
| Rate for Payer: University Health Alliance Commercial |
$94.79
|
|
|
HCHG TM JOINTS BIL
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 70330
|
| Hospital Charge Code |
H3200794
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
|
