|
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
|
|
|
HCHG LITHIUM
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
H3010842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$133.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$146.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.61
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$133.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.20
|
| Rate for Payer: University Health Alliance Commercial |
$17.09
|
|
|
HCHG LITHIUM
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
H3010842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
HCHG LIVER-KIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HCHG LIVER-KIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
H3020632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$109.89 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$99.90
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$109.89
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.55
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$99.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.90
|
| Rate for Payer: University Health Alliance Commercial |
$37.61
|
|
|
HCHG LRT IAD 18BCT/8VIR&7ARG RNA
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 0528U
|
| Hospital Charge Code |
H3001129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$793.55 |
| Max. Negotiated Rate |
$1,876.05 |
| Rate for Payer: AlohaCare Medicaid |
$947.50
|
| Rate for Payer: AlohaCare Medicare |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Devoted Health Medicare |
$1,876.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$793.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,705.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,800.25
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Humana Medicare |
$1,705.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$966.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,705.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,705.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,705.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,705.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,381.27
|
|
|
HCHG LRT IAD 18BCT/8VIR&7ARG RNA
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 0528U
|
| Hospital Charge Code |
H3001129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,610.75 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
|
|
HCHG L-SPINE FLEX EXT ONLY, 2-3 VIEWS
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
H3200554
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG L-SPINE FLEX EXT ONLY, 2-3 VIEWS
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
H3200554
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
HCHG LS SPINE 2 VIEWS
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
H3200546
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
HCHG LS SPINE 2 VIEWS
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
H3200546
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG LS SPINE 2 VIEWS PORT
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
H3200548
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.60 |
| Max. Negotiated Rate |
$655.72 |
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
|
|
HCHG LS SPINE 2 VIEWS PORT
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
HCPCS 72100
|
| Hospital Charge Code |
H3200548
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$669.24 |
| Rate for Payer: AlohaCare Medicaid |
$338.00
|
| Rate for Payer: AlohaCare Medicare |
$608.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Cash Price |
$439.40
|
| Rate for Payer: Devoted Health Medicare |
$669.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$608.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$574.60
|
| Rate for Payer: Humana Medicare |
$608.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$608.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$344.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$608.40
|
| Rate for Payer: MDX Hawaii PPO |
$655.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$608.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$608.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$608.40
|
| Rate for Payer: University Health Alliance Commercial |
$77.64
|
|
|
HCHG LS SPINE MIN 4 VIEWS
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
H3200552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
HCHG LS SPINE MIN 4 VIEWS
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 72110
|
| Hospital Charge Code |
H3200552
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.35 |
| Max. Negotiated Rate |
$750.42 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$682.20
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$750.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$33.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$682.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$682.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.20
|
| Rate for Payer: University Health Alliance Commercial |
$108.35
|
|
|
HCHG LS SPINE MULT BENDING 2 OR 3 VIEWS
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
H3200960
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$700.92 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$637.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$700.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.64
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$637.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$637.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$637.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$637.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$637.20
|
| Rate for Payer: University Health Alliance Commercial |
$97.90
|
|
|
HCHG LS SPINE MULT BENDING 2 OR 3 VIEWS
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 72120
|
| Hospital Charge Code |
H3200960
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
HCHG LUPUS ANTICOAGULANT DRVVT
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
H3050280
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$71.78 |
| Rate for Payer: Cash Price |
$48.10
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.60
|
| Rate for Payer: MDX Hawaii PPO |
$71.78
|
|
|
HCHG LUPUS ANTICOAGULANT DRVVT
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
H3050280
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$73.26 |
| Rate for Payer: AlohaCare Medicaid |
$37.00
|
| Rate for Payer: AlohaCare Medicare |
$66.60
|
| Rate for Payer: Cash Price |
$48.10
|
| Rate for Payer: Cash Price |
$48.10
|
| Rate for Payer: Devoted Health Medicare |
$73.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.58
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Humana Medicare |
$66.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.60
|
| Rate for Payer: MDX Hawaii PPO |
$71.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.60
|
| Rate for Payer: University Health Alliance Commercial |
$24.73
|
|
|
HCHG LUTEINIZING HORMONE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 83002
|
| Hospital Charge Code |
H3010844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$135.63 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$123.30
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Devoted Health Medicare |
$135.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.52
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$123.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$123.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.30
|
| Rate for Payer: University Health Alliance Commercial |
$47.88
|
|
|
HCHG LUTEINIZING HORMONE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 83002
|
| Hospital Charge Code |
H3010844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$89.05
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HCHG LYME DISEASE ABS IMMUNOBLOT
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
H3020994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$100.30 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.20
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
|
|
HCHG LYME DISEASE ABS IMMUNOBLOT
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 86617
|
| Hospital Charge Code |
H3020994
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$116.82 |
| Rate for Payer: AlohaCare Medicaid |
$59.00
|
| Rate for Payer: AlohaCare Medicare |
$106.20
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Devoted Health Medicare |
$116.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.49
|
| Rate for Payer: Health Management Network Commercial |
$100.30
|
| Rate for Payer: Humana Medicare |
$106.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.20
|
| Rate for Payer: MDX Hawaii PPO |
$114.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.20
|
| Rate for Payer: University Health Alliance Commercial |
$40.03
|
|
|
HCHG MAGNESIUM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
H3010846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: AlohaCare Medicaid |
$62.50
|
| Rate for Payer: AlohaCare Medicare |
$112.50
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Devoted Health Medicare |
$123.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.70
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Humana Medicare |
$112.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$17.32
|
|
|
HCHG MAGNESIUM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
H3010846
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
|
