|
Specific Gravity,Fluid FSI
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 84315
|
| Hospital Charge Code |
8404528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$16.50
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Devoted Health Medicare |
$18.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.28
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$16.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.50
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.50
|
| Rate for Payer: University Health Alliance Commercial |
$6.47
|
|
|
Specific Gravity,Fluid FSI
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 84315
|
| Hospital Charge Code |
8404528
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
Specific Gravity Urine††FSI
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
8404427
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
Specific Gravity Urine††FSI
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
8404427
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$18.50
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$20.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.50
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.50
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
Specimen Collection Covid-19, Any Specimen Source-Clinic
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS C9803
|
| Hospital Charge Code |
8955808
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.46
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
Specimen Covid-19, Any Specimen Source-Drive Through
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS C9803
|
| Hospital Charge Code |
8955809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$68.85 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: MDX Hawaii PPO |
$78.57
|
|
|
Specimen Covid-19, Any Specimen Source-Drive Through
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS C9803
|
| Hospital Charge Code |
8955809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$78.57 |
| Rate for Payer: AlohaCare Medicaid |
$40.50
|
| Rate for Payer: AlohaCare Medicare |
$40.50
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Devoted Health Medicare |
$44.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$76.95
|
| Rate for Payer: Health Management Network Commercial |
$68.85
|
| Rate for Payer: Humana Medicare |
$40.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.50
|
| Rate for Payer: MDX Hawaii PPO |
$78.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.50
|
| Rate for Payer: University Health Alliance Commercial |
$45.36
|
|
|
Specimen Covid-19, Any Specimen Source-ED Tech
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS C9803
|
| Hospital Charge Code |
8955810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
Specimen Covid-19, Any Specimen Source-ED Tech
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS C9803
|
| Hospital Charge Code |
8955810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$45.50
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$50.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$45.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.50
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.96
|
|
|
Specimen to lab - Urinary Catheter Management:
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
4607648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
Specimen to lab - Urinary Catheter Management:
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS P9612
|
| Hospital Charge Code |
4607648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$18.50
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$20.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.15
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.50
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.50
|
| Rate for Payer: University Health Alliance Commercial |
$20.72
|
|
|
Speech Fluency Eval Charge
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 92521 GO,CO
|
| Hospital Charge Code |
8169581
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$140.32 |
| Max. Negotiated Rate |
$754.66 |
| Rate for Payer: AlohaCare Medicaid |
$389.00
|
| Rate for Payer: AlohaCare Medicare |
$389.00
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Devoted Health Medicare |
$427.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$389.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$739.10
|
| Rate for Payer: Health Management Network Commercial |
$661.30
|
| Rate for Payer: Humana Medicare |
$389.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$396.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$389.00
|
| Rate for Payer: MDX Hawaii PPO |
$754.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$389.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$389.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$140.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$389.00
|
| Rate for Payer: University Health Alliance Commercial |
$435.68
|
|
|
Speech Fluency Eval Charge
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 92521 GO,CO
|
| Hospital Charge Code |
8169581
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$661.30 |
| Max. Negotiated Rate |
$754.66 |
| Rate for Payer: Cash Price |
$505.70
|
| Rate for Payer: Health Management Network Commercial |
$661.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$700.20
|
| Rate for Payer: MDX Hawaii PPO |
$754.66
|
|
|
Speech Generating Device Evaluation 1st hr Charge
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 92607 GO,CO
|
| Hospital Charge Code |
8171791
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$351.05 |
| Max. Negotiated Rate |
$400.61 |
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Health Management Network Commercial |
$351.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.70
|
| Rate for Payer: MDX Hawaii PPO |
$400.61
|
|
|
Speech Generating Device Evaluation 1st hr Charge
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 92607 GO,CO
|
| Hospital Charge Code |
8171791
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$400.61 |
| Rate for Payer: AlohaCare Medicaid |
$206.50
|
| Rate for Payer: AlohaCare Medicare |
$206.50
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Cash Price |
$268.45
|
| Rate for Payer: Devoted Health Medicare |
$227.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$392.35
|
| Rate for Payer: Health Management Network Commercial |
$351.05
|
| Rate for Payer: Humana Medicare |
$206.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$371.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.50
|
| Rate for Payer: MDX Hawaii PPO |
$400.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$206.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.50
|
| Rate for Payer: University Health Alliance Commercial |
$231.28
|
|
|
Speech Generating Device Service Charge
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 92608 GO,CO
|
| Hospital Charge Code |
8177112
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$17.26 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: AlohaCare Medicaid |
$113.50
|
| Rate for Payer: AlohaCare Medicare |
$113.50
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Devoted Health Medicare |
$124.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$113.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$215.65
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Humana Medicare |
$113.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$113.50
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$113.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$113.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$113.50
|
| Rate for Payer: University Health Alliance Commercial |
$127.12
|
|
|
Speech Generating Device Service Charge
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 92608 GO,CO
|
| Hospital Charge Code |
8177112
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$192.95 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.30
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
|
|
Speech Sound Production Eval Charge
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 92522 GP,59
|
| Hospital Charge Code |
8169587
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$565.25 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Health Management Network Commercial |
$565.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$598.50
|
| Rate for Payer: MDX Hawaii PPO |
$645.05
|
|
|
Speech Sound Production Eval Charge
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 92522 GP,59
|
| Hospital Charge Code |
8169587
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$645.05 |
| Rate for Payer: AlohaCare Medicaid |
$332.50
|
| Rate for Payer: AlohaCare Medicare |
$332.50
|
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Cash Price |
$432.25
|
| Rate for Payer: Devoted Health Medicare |
$365.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$332.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$631.75
|
| Rate for Payer: Health Management Network Commercial |
$565.25
|
| Rate for Payer: Humana Medicare |
$332.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$598.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$339.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$332.50
|
| Rate for Payer: MDX Hawaii PPO |
$645.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$332.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$332.50
|
| Rate for Payer: University Health Alliance Commercial |
$372.40
|
|
|
Speech Sound Prod w/ Language Charge
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 92523 GO,CO
|
| Hospital Charge Code |
8170124
|
|
Hospital Revenue Code
|
444
|
| 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: Kaiser Permanente Commercial |
$514.80
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
|
|
Speech Sound Prod w/ Language Charge
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 92523 GP,59
|
| Hospital Charge Code |
8177184
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$240.61 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: AlohaCare Medicaid |
$286.00
|
| Rate for Payer: AlohaCare Medicare |
$286.00
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Devoted Health Medicare |
$314.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: Humana Medicare |
$286.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.00
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.00
|
| Rate for Payer: University Health Alliance Commercial |
$320.32
|
|
|
Speech Sound Prod w/ Language Charge
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 92523 GO,CO
|
| Hospital Charge Code |
8170124
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$240.61 |
| Max. Negotiated Rate |
$554.84 |
| Rate for Payer: AlohaCare Medicaid |
$286.00
|
| Rate for Payer: AlohaCare Medicare |
$286.00
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Cash Price |
$371.80
|
| Rate for Payer: Devoted Health Medicare |
$314.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$286.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$543.40
|
| Rate for Payer: Health Management Network Commercial |
$486.20
|
| Rate for Payer: Humana Medicare |
$286.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$286.00
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$286.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$286.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$286.00
|
| Rate for Payer: University Health Alliance Commercial |
$320.32
|
|
|
Speech Sound Prod w/ Language Charge
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 92523 GP,59
|
| Hospital Charge Code |
8177184
|
|
Hospital Revenue Code
|
444
|
| 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: Kaiser Permanente Commercial |
$514.80
|
| Rate for Payer: MDX Hawaii PPO |
$554.84
|
|
|
Sperm, Post Vasectomy FSI
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 89300
|
| Hospital Charge Code |
8118048
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
Sperm, Post Vasectomy FSI
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 89300
|
| Hospital Charge Code |
8118048
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: AlohaCare Medicaid |
$52.50
|
| Rate for Payer: AlohaCare Medicare |
$52.50
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Cash Price |
$68.25
|
| Rate for Payer: Devoted Health Medicare |
$57.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.84
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$52.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.50
|
| Rate for Payer: University Health Alliance Commercial |
$23.03
|
|
