|
ROOM/BED: Observation
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2120846
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: AlohaCare Medicaid |
$81.50
|
| Rate for Payer: AlohaCare Medicare |
$81.50
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Devoted Health Medicare |
$89.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,200.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.85
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Humana Medicare |
$81.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.50
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.50
|
| Rate for Payer: University Health Alliance Commercial |
$118.81
|
|
|
ROOM/BED: Observation
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
2120846
|
|
Hospital Revenue Code
|
762
|
| 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: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
ROOM/BED: Private
|
Facility
|
IP
|
$3,725.00
|
|
| Hospital Charge Code |
8081565
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,166.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,352.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,613.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Private
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
8081565
|
|
Hospital Revenue Code
|
114
|
| Min. Negotiated Rate |
$3,098.25 |
| Max. Negotiated Rate |
$4,365.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: Cash Price |
$2,925.00
|
| Rate for Payer: Cash Price |
$2,925.00
|
| Rate for Payer: Cash Price |
$2,925.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,200.00
|
| Rate for Payer: Health Management Network Commercial |
$3,825.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,365.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: University Health Alliance Commercial |
$3,150.00
|
|
|
ROOM/BED: Private OB
|
Facility
|
IP
|
$3,725.00
|
|
| Hospital Charge Code |
8081565
|
|
Hospital Revenue Code
|
112
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,166.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,352.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,613.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Private SNF
|
Facility
|
IP
|
$3,200.00
|
|
| Hospital Charge Code |
8081565
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$761.50 |
| Max. Negotiated Rate |
$3,104.00 |
| Rate for Payer: AlohaCare Medicaid |
$761.50
|
| Rate for Payer: AlohaCare Medicare |
$2,801.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Devoted Health Medicare |
$3,081.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$761.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,801.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$761.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$2,720.00
|
| Rate for Payer: Humana Medicare |
$2,801.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,880.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$761.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,801.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,104.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$761.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,801.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$761.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,801.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
ROOM/BED: Private Waitlist
|
Facility
|
IP
|
$3,100.00
|
|
| Hospital Charge Code |
8081565
|
|
Hospital Revenue Code
|
111
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,635.00
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,790.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,007.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
ROOM/BED: Semi-Private
|
Facility
|
IP
|
$4,500.00
|
|
| Hospital Charge Code |
8078890
|
|
Hospital Revenue Code
|
124
|
| Min. Negotiated Rate |
$3,098.25 |
| Max. Negotiated Rate |
$4,365.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: Cash Price |
$2,925.00
|
| Rate for Payer: Cash Price |
$2,925.00
|
| Rate for Payer: Cash Price |
$2,925.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,200.00
|
| Rate for Payer: Health Management Network Commercial |
$3,825.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,050.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: MDX Hawaii PPO |
$4,365.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: University Health Alliance Commercial |
$3,150.00
|
|
|
ROOM/BED: Semi-Private
|
Facility
|
IP
|
$3,725.00
|
|
| Hospital Charge Code |
8078890
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,166.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,352.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,613.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Semi-Private OB
|
Facility
|
IP
|
$3,725.00
|
|
| Hospital Charge Code |
8078890
|
|
Hospital Revenue Code
|
122
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Cash Price |
$2,421.25
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$3,166.25
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,352.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,613.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Semi-Private SNF
|
Facility
|
IP
|
$3,310.00
|
|
| Hospital Charge Code |
8078890
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$761.50 |
| Max. Negotiated Rate |
$3,210.70 |
| Rate for Payer: AlohaCare Medicaid |
$761.50
|
| Rate for Payer: AlohaCare Medicare |
$2,801.00
|
| Rate for Payer: Cash Price |
$2,151.50
|
| Rate for Payer: Cash Price |
$2,151.50
|
| Rate for Payer: Devoted Health Medicare |
$3,081.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$761.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,801.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$761.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$2,813.50
|
| Rate for Payer: Humana Medicare |
$2,801.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,979.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$761.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,801.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,210.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$761.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,801.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$761.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,801.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
ROOM/BED: Semi-Private Swing
|
Facility
|
IP
|
$3,000.00
|
|
| Hospital Charge Code |
8078890
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$5,923.00 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$2,801.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Devoted Health Medicare |
$3,081.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$890.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,801.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,350.00
|
| Rate for Payer: Health Management Network Commercial |
$2,550.00
|
| Rate for Payer: Humana Medicare |
$2,801.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,700.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,801.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,910.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,801.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,801.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
ROOM/BED: Semi-Private Waitlist
|
Facility
|
IP
|
$3,100.00
|
|
| Hospital Charge Code |
8078890
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$486.76 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$486.76
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Cash Price |
$2,015.00
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$486.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$486.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$2,635.00
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,790.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$486.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,007.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$486.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,320.00
|
|
|
ROOM/BED: Telemetry
|
Facility
|
IP
|
$6,600.00
|
|
| Hospital Charge Code |
2120847
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,476.00 |
| Max. Negotiated Rate |
$8,900.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$4,290.00
|
| Rate for Payer: Cash Price |
$4,290.00
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,900.00
|
| Rate for Payer: Health Management Network Commercial |
$5,610.00
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,940.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,402.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$6,369.00
|
|
|
ROOM/BED: Ward
|
Facility
|
IP
|
$1,100.00
|
|
| Hospital Charge Code |
8163848
|
|
Hospital Revenue Code
|
150
|
| Min. Negotiated Rate |
$935.00 |
| Max. Negotiated Rate |
$7,250.00 |
| Rate for Payer: AlohaCare Medicaid |
$3,098.25
|
| Rate for Payer: AlohaCare Medicare |
$2,476.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Devoted Health Medicare |
$2,723.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3,098.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,476.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3,098.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,250.00
|
| Rate for Payer: Health Management Network Commercial |
$935.00
|
| Rate for Payer: Humana Medicare |
$2,476.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$990.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,098.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,476.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,067.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,098.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,476.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3,098.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,476.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,923.00
|
|
|
RPR (Syphillis) FSI
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
8118037
|
|
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: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
RPR (Syphillis) FSI
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
8118037
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$44.50
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$48.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$44.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.50
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
.RPR Titer
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
9189931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$20.50
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$22.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.40
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Humana Medicare |
$20.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.50
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.40
|
|
|
.RPR Titer
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
9189931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
RPR w/ Reflex to Titer FSI
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
8118038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$44.50
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$48.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$44.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.50
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
RPR w/ Reflex to Titer FSI
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
8118038
|
|
Hospital Revenue Code
|
300
|
| 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: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
RSV Antigen Detection FSI
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87807 QW
|
| Hospital Charge Code |
8228915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
RSV Antigen Detection FSI
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87807 QW
|
| Hospital Charge Code |
8228915
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$76.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.10
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$69.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.50
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
RSV Antigen Rfx PCR FSI
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87420
|
| Hospital Charge Code |
8228916
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$76.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.91
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$69.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.50
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
RSV Antigen Rfx PCR FSI
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87420
|
| Hospital Charge Code |
8228916
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
