|
glucagon 1 mg kit [HHSC]
|
Facility
|
OP
|
$944.24
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
2500358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.91 |
| Max. Negotiated Rate |
$915.91 |
| Rate for Payer: AlohaCare Medicaid |
$472.12
|
| Rate for Payer: AlohaCare Medicaid |
$469.67
|
| Rate for Payer: AlohaCare Medicare |
$472.12
|
| Rate for Payer: AlohaCare Medicare |
$469.67
|
| Rate for Payer: Cash Price |
$610.57
|
| Rate for Payer: Cash Price |
$610.57
|
| Rate for Payer: Cash Price |
$613.76
|
| Rate for Payer: Cash Price |
$613.76
|
| Rate for Payer: Devoted Health Medicare |
$519.33
|
| Rate for Payer: Devoted Health Medicare |
$516.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$195.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$182.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$182.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$469.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$195.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$897.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$892.37
|
| Rate for Payer: Health Management Network Commercial |
$802.60
|
| Rate for Payer: Health Management Network Commercial |
$798.44
|
| Rate for Payer: Humana Medicare |
$469.67
|
| Rate for Payer: Humana Medicare |
$472.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$849.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$845.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$479.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$481.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$469.67
|
| Rate for Payer: MDX Hawaii PPO |
$915.91
|
| Rate for Payer: MDX Hawaii PPO |
$911.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$469.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$472.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$469.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$563.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$566.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$469.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.12
|
| Rate for Payer: University Health Alliance Commercial |
$688.26
|
| Rate for Payer: University Health Alliance Commercial |
$684.68
|
|
|
Glucose 1 Hour Post 50 Gram Glucola FSI
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
8117924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
Glucose 1 Hour Post 50 Gram Glucola FSI
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
8117924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$33.50
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$36.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$33.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.50
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Glucose 2hr post 75g FSI
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
8331286
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| 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 |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| 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 |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Glucose 2hr post 75g FSI
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
8331286
|
|
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
|
|
|
Glucose 2 hr PP FSI
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
8404416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
Glucose 2 hr PP FSI
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
8404416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$24.50
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$26.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$24.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.50
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose 6 phosphate dehydrogenase G6PD Quant FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
8117925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$62.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.70
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$25.07
|
|
|
Glucose 6 phosphate dehydrogenase G6PD Quant FSI
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
8117925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
Glucose (Arterial) POCT
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
9364703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$24.50
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$26.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$24.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.50
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose (Arterial) POCT
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
9364703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
Glucose, Body Fluid FSI
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
8228872
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
Glucose, Body Fluid FSI
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
8228872
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.50
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose, CSF REF
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
8159898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
Glucose, CSF REF
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
8159898
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.50
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose FSI
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
8117926
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$24.50
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$26.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$24.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.50
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose FSI
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
8117926
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
Glucose Monitoring Device POC
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
7750708
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| 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 |
$4.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.04
|
| 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 |
$4.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.50
|
| Rate for Payer: University Health Alliance Commercial |
$8.20
|
|
|
Glucose Monitoring Device POC
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82948
|
| Hospital Charge Code |
7750708
|
|
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
|
|
|
Glucose POCT
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
1635509
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
Glucose POCT
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
1635509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.50 |
| 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 |
$2.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.28
|
| 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 |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.68
|
|
|
Glucose Tolerance OB 3 Hour FSI
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
8117927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.30
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
|
|
Glucose Tolerance OB 3 Hour FSI
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
8117927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: AlohaCare Medicaid |
$73.50
|
| Rate for Payer: AlohaCare Medicare |
$73.50
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Devoted Health Medicare |
$80.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.87
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Humana Medicare |
$73.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.50
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.50
|
| Rate for Payer: University Health Alliance Commercial |
$33.28
|
|
|
Glucose (Venous) POCT
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
9364732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$24.50
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$26.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$24.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.50
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Glucose (Venous) POCT
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
9364732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
