|
Glucerna 237 mL liquid [KMC]
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
NDC 070074509051
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$12.49 |
| Rate for Payer: AlohaCare Medicaid |
$6.44
|
| Rate for Payer: AlohaCare Medicare |
$5.41
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$11.85
|
| Rate for Payer: Devoted Health Medicare |
$5.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.24
|
| Rate for Payer: Health Management Network Commercial |
$10.95
|
| Rate for Payer: Humana Medicare |
$5.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.41
|
| Rate for Payer: MDX Hawaii PPO |
$12.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.41
|
| Rate for Payer: University Health Alliance Commercial |
$9.39
|
|
|
Glucose 1 Hour PP
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
422829500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
Glucose 1 Hour PP
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
422829500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$18.48
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$40.48
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$18.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.48
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.48
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Glucose, 1 Hr Pregnancy Screen DLS
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
422829505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$18.48
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$40.48
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$18.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.48
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.48
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Glucose, 1 Hr Pregnancy Screen DLS
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
422829505
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
Glucose 2 Hour Post Prandial
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
422829500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$18.48
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$40.48
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$18.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.48
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.48
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Glucose 2 Hour Post Prandial
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
422829500
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
|
|
glucose 40% Oral Gel [KMC]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 00574006930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: AlohaCare Medicaid |
$0.21
|
| Rate for Payer: AlohaCare Medicare |
$0.18
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$0.39
|
| Rate for Payer: Devoted Health Medicare |
$0.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network Commercial |
$0.36
|
| Rate for Payer: Humana Medicare |
$0.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.18
|
| Rate for Payer: MDX Hawaii PPO |
$0.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.18
|
| Rate for Payer: University Health Alliance Commercial |
$0.31
|
|
|
glucose 40% Oral Gel [KMC]
|
Facility
|
IP
|
$0.42
|
|
|
Service Code
|
NDC 00574006930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Health Management Network Commercial |
$0.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.38
|
| Rate for Payer: MDX Hawaii PPO |
$0.41
|
|
|
GLUCOSE BLOOD REAGENT STRIP
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: AlohaCare Medicaid |
$4.37
|
| Rate for Payer: AlohaCare Medicare |
$5.04
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Devoted Health Medicare |
$5.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.04
|
|
|
Glucose, CSF DLS
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
422829455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
Glucose, CSF DLS
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
422829455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$36.80
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.80
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.80
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose Fasting
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
422829470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$36.80
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.80
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.80
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose Fasting
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
422829470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
Glucose Level
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
422829470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
Glucose Level
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
422829470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$16.80
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$36.80
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$16.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.80
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.80
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose, POC
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
317829620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$34.04
|
| Rate for Payer: Devoted Health Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.54
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose, POC
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
317829620
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 82947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: AlohaCare Medicaid |
$5.42
|
| Rate for Payer: AlohaCare Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$3.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.43
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.93
|
|
|
Glutamic Acid Decarboxylase Ab DLS
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
24050432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: AlohaCare Medicaid |
$51.00
|
| Rate for Payer: AlohaCare Medicare |
$42.84
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$93.84
|
| Rate for Payer: Devoted Health Medicare |
$42.84
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$25.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Humana Medicare |
$42.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.84
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.84
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
|
|
Glutamic Acid Decarboxylase Ab DLS
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
24050432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
|
|
Glutamine 15gm packet[KMC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 43900028300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
Glutamine 15gm packet[KMC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 43900028300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.26
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2.76
|
| Rate for Payer: Devoted Health Medicare |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.26
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.26
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
glyBURIDE 2.5 mg Tab [KMC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00093834301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
glyBURIDE 2.5 mg Tab [KMC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00093834301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.26
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2.76
|
| Rate for Payer: Devoted Health Medicare |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.26
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.26
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
