|
HCHG NON-ENTERIC SENSITIVITY ISO EA PER PLATE
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
H3060697
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$271.15 |
| Max. Negotiated Rate |
$309.43 |
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
|
|
HCHG NONINVAS OXIMETRY MULT
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
H4600120
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$195.03 |
| Rate for Payer: AlohaCare Medicaid |
$98.50
|
| Rate for Payer: AlohaCare Medicare |
$177.30
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Devoted Health Medicare |
$195.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$177.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.15
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Humana Medicare |
$177.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$177.30
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$177.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$177.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$177.30
|
| Rate for Payer: University Health Alliance Commercial |
$143.59
|
|
|
HCHG NONINVAS OXIMETRY MULT
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
H4600120
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$167.45 |
| Max. Negotiated Rate |
$191.09 |
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
|
|
HCHG NPPV SUBSEQUENT DAY
|
Facility
|
IP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
H4100281
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$872.10 |
| Max. Negotiated Rate |
$995.22 |
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Health Management Network Commercial |
$872.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$923.40
|
| Rate for Payer: MDX Hawaii PPO |
$995.22
|
|
|
HCHG NPPV SUBSEQUENT DAY
|
Facility
|
OP
|
$1,026.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
H4100281
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$39.67 |
| Max. Negotiated Rate |
$1,015.74 |
| Rate for Payer: AlohaCare Medicaid |
$513.00
|
| Rate for Payer: AlohaCare Medicare |
$923.40
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Devoted Health Medicare |
$1,015.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$923.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$974.70
|
| Rate for Payer: Health Management Network Commercial |
$872.10
|
| Rate for Payer: Humana Medicare |
$923.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$923.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$523.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$923.40
|
| Rate for Payer: MDX Hawaii PPO |
$995.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$923.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$923.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$923.40
|
| Rate for Payer: University Health Alliance Commercial |
$747.85
|
|
|
HCHG NT PROBNP
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
H3011556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$496.98 |
| Rate for Payer: AlohaCare Medicaid |
$251.00
|
| Rate for Payer: AlohaCare Medicare |
$451.80
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Devoted Health Medicare |
$496.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$49.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$451.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.26
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Humana Medicare |
$451.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$451.80
|
| Rate for Payer: MDX Hawaii PPO |
$486.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$451.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$451.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$451.80
|
| Rate for Payer: University Health Alliance Commercial |
$87.75
|
|
|
HCHG NT PROBNP
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
H3011556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$486.94 |
| Rate for Payer: Cash Price |
$326.30
|
| Rate for Payer: Health Management Network Commercial |
$426.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$451.80
|
| Rate for Payer: MDX Hawaii PPO |
$486.94
|
|
|
HCHG OBSTETRIC PANEL
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 80055
|
| Hospital Charge Code |
H3010986
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$296.01 |
| Rate for Payer: AlohaCare Medicaid |
$149.50
|
| Rate for Payer: AlohaCare Medicare |
$269.10
|
| Rate for Payer: Cash Price |
$194.35
|
| Rate for Payer: Cash Price |
$194.35
|
| Rate for Payer: Devoted Health Medicare |
$296.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.81
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Humana Medicare |
$269.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$152.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$269.10
|
| Rate for Payer: MDX Hawaii PPO |
$290.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$269.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.10
|
| Rate for Payer: University Health Alliance Commercial |
$217.94
|
|
|
HCHG OBSTETRIC PANEL
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 80055
|
| Hospital Charge Code |
H3010986
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$254.15 |
| Max. Negotiated Rate |
$290.03 |
| Rate for Payer: Cash Price |
$194.35
|
| Rate for Payer: Health Management Network Commercial |
$254.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$269.10
|
| Rate for Payer: MDX Hawaii PPO |
$290.03
|
|
|
HCHG OCCULT BLOOD FECES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
H3011713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$48.51 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$44.10
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$48.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$44.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.10
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HCHG OCCULT BLOOD FECES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
H3011713
|
|
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
|
|
|
HCHG OCCULT BLOOD GASTRIC - 90
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
H3011667
|
|
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
|
|
|
HCHG OCCULT BLOOD GASTRIC - 90
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
H3011667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$48.51 |
| Rate for Payer: AlohaCare Medicaid |
$24.50
|
| Rate for Payer: AlohaCare Medicare |
$44.10
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Cash Price |
$31.85
|
| Rate for Payer: Devoted Health Medicare |
$48.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.32
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Humana Medicare |
$44.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.10
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HCHG OLIGOCLONAL BANDS
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS 83916
|
| Hospital Charge Code |
H3010990
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$164.05 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Cash Price |
$125.45
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.70
|
| Rate for Payer: MDX Hawaii PPO |
$187.21
|
|
|
HCHG OLIGOCLONAL BANDS
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS 83916
|
| Hospital Charge Code |
H3010990
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$191.07 |
| Rate for Payer: AlohaCare Medicaid |
$96.50
|
| Rate for Payer: AlohaCare Medicare |
$173.70
|
| Rate for Payer: Cash Price |
$125.45
|
| Rate for Payer: Cash Price |
$125.45
|
| Rate for Payer: Devoted Health Medicare |
$191.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.39
|
| Rate for Payer: Health Management Network Commercial |
$164.05
|
| Rate for Payer: Humana Medicare |
$173.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.70
|
| Rate for Payer: MDX Hawaii PPO |
$187.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.70
|
| Rate for Payer: University Health Alliance Commercial |
$51.97
|
|
|
HCHG OPIATES 1+ DRUG CONFIRM 90
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
H3011582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.89 |
| Max. Negotiated Rate |
$132.66 |
| Rate for Payer: AlohaCare Medicaid |
$67.00
|
| Rate for Payer: AlohaCare Medicare |
$120.60
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$132.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.30
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$120.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.60
|
| Rate for Payer: University Health Alliance Commercial |
$97.67
|
|
|
HCHG OPIATES 1+ DRUG CONFIRM 90
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
H3011582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
HCHG OP INTRAOP CHOLANGIO PORT
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
H3200600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$657.36 |
| Rate for Payer: AlohaCare Medicaid |
$332.00
|
| Rate for Payer: AlohaCare Medicare |
$597.60
|
| Rate for Payer: Cash Price |
$431.60
|
| Rate for Payer: Cash Price |
$431.60
|
| Rate for Payer: Devoted Health Medicare |
$657.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$597.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$630.80
|
| Rate for Payer: Health Management Network Commercial |
$564.40
|
| Rate for Payer: Humana Medicare |
$597.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$597.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$338.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$597.60
|
| Rate for Payer: MDX Hawaii PPO |
$644.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$597.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$597.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$597.60
|
| Rate for Payer: University Health Alliance Commercial |
$483.99
|
|
|
HCHG OP INTRAOP CHOLANGIO PORT
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
HCPCS 74300
|
| Hospital Charge Code |
H3200600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$644.08 |
| Rate for Payer: Cash Price |
$431.60
|
| Rate for Payer: Health Management Network Commercial |
$564.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$597.60
|
| Rate for Payer: MDX Hawaii PPO |
$644.08
|
|
|
HCHG ORGANISM ID UR1
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
H3060665
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.09 |
| 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 |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.09
|
| 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 |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.20
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
HCHG ORGANISM ID UR1
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
H3060665
|
|
Hospital Revenue Code
|
306
|
| 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 OSMOLALITY-SERUM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
H3011006
|
|
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
|
|
|
HCHG OSMOLALITY-SERUM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 83930
|
| Hospital Charge Code |
H3011006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.61 |
| 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 |
$9.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| 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 |
$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 |
$9.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$17.09
|
|
|
HCHG OSMOLALITY-URINE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
H3011008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: AlohaCare Medicaid |
$51.00
|
| Rate for Payer: AlohaCare Medicare |
$91.80
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Devoted Health Medicare |
$100.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.82
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Humana Medicare |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.80
|
| Rate for Payer: University Health Alliance Commercial |
$17.61
|
|
|
HCHG OSMOLALITY-URINE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 83935
|
| Hospital Charge Code |
H3011008
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
