|
HCHG LARYNGOSCOPY DIR REMOVE FB
|
Facility
|
IP
|
$5,243.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
H4500852
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,456.55 |
| Max. Negotiated Rate |
$5,085.71 |
| Rate for Payer: Cash Price |
$3,407.95
|
| Rate for Payer: Health Management Network Commercial |
$4,456.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,718.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,085.71
|
|
|
HCHG LARYNGOSCOPY DIR REMOVE FB
|
Facility
|
OP
|
$5,243.00
|
|
|
Service Code
|
HCPCS 31530
|
| Hospital Charge Code |
H4500852
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,190.57 |
| Rate for Payer: AlohaCare Medicaid |
$2,621.50
|
| Rate for Payer: AlohaCare Medicare |
$4,718.70
|
| Rate for Payer: Cash Price |
$3,407.95
|
| Rate for Payer: Cash Price |
$3,407.95
|
| Rate for Payer: Devoted Health Medicare |
$5,190.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,718.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,980.85
|
| Rate for Payer: Health Management Network Commercial |
$4,456.55
|
| Rate for Payer: Humana Medicare |
$4,718.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,718.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,718.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,085.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,718.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,718.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,718.70
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG LARYNGOSCOPY FLEX DX
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
H4500556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$595.00
|
| Rate for Payer: AlohaCare Medicare |
$1,071.00
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Devoted Health Medicare |
$1,178.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,071.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,130.50
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$1,071.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,071.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,071.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,071.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,071.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HCHG LARYNGOSCOPY FLEX DX
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 31575
|
| Hospital Charge Code |
H4500556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
|
|
HCHG LDH
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
H3010814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: AlohaCare Medicaid |
$56.00
|
| Rate for Payer: AlohaCare Medicare |
$100.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$110.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.80
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
HCHG LDH
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
H3010814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
|
|
HCHG LDH BODY FLUID
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
H3010816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$108.64 |
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
|
|
HCHG LDH BODY FLUID
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
H3010816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: AlohaCare Medicaid |
$56.00
|
| Rate for Payer: AlohaCare Medicare |
$100.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Devoted Health Medicare |
$110.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$95.20
|
| Rate for Payer: Humana Medicare |
$100.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.80
|
| Rate for Payer: MDX Hawaii PPO |
$108.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.80
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
HCHG LDH CSF
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
H3010818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$43.56 |
| Rate for Payer: AlohaCare Medicaid |
$22.00
|
| Rate for Payer: AlohaCare Medicare |
$39.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Devoted Health Medicare |
$43.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$37.40
|
| Rate for Payer: Humana Medicare |
$39.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.60
|
| Rate for Payer: MDX Hawaii PPO |
$42.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.60
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
HCHG LDH CSF
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
H3010818
|
|
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
|
|
|
HCHG LEAD BLOOD
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
H3010822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: AlohaCare Medicaid |
$42.50
|
| Rate for Payer: AlohaCare Medicare |
$76.50
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$84.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Humana Medicare |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.28
|
|
|
HCHG LEAD BLOOD
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
H3010822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
|
|
HCHG LEGION PNEUMO DNA AMP PROBE - 90
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
H3060802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
HCHG LEGION PNEUMO DNA AMP PROBE - 90
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
H3060802
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$235.62 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$214.20
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$235.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$214.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$214.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.20
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG LEPTOSPIRA AB 90
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
H3020630
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$120.78 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$109.80
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Devoted Health Medicare |
$120.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$109.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.80
|
| Rate for Payer: University Health Alliance Commercial |
$34.10
|
|
|
HCHG LEPTOSPIRA AB 90
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
H3020630
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HCHG LEVEL IV GROSS MICRO EXAM
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
H3120307
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$407.88 |
| Rate for Payer: Kaiser Permanente Medicare |
$370.80
|
| Rate for Payer: AlohaCare Medicaid |
$206.00
|
| Rate for Payer: AlohaCare Medicare |
$370.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Devoted Health Medicare |
$407.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$66.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$370.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.24
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Humana Medicare |
$370.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.12
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$370.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$370.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$370.80
|
| Rate for Payer: University Health Alliance Commercial |
$207.96
|
|
|
HCHG LEVEL IV GROSS MICRO EXAM
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
H3120307
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.80
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
|
|
HCHG LEVETIRACETAM QUANT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
H3011340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG LEVETIRACETAM QUANT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
H3011340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG LIPASE
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: AlohaCare Medicaid |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$115.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$126.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$115.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.20
|
| Rate for Payer: University Health Alliance Commercial |
$17.80
|
|
|
HCHG LIPASE
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
HCHG LIPASE BODY FLUID
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: AlohaCare Medicaid |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$115.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$126.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$115.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.20
|
| Rate for Payer: University Health Alliance Commercial |
$17.80
|
|
|
HCHG LIPASE BODY FLUID
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
H3010832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
HCHG LIPOPROTEIN A
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
H3011385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$98.10
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Devoted Health Medicare |
$107.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$98.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.32
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$98.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$98.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$98.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
