|
HCHG POTASSIUM SERUM/PLASMA/WHOLE BLOOD
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
H3011066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG POTASSIUM SERUM/PLASMA/WHOLE BLOOD
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
H3011066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$33.30
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$36.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.76
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.30
|
| Rate for Payer: University Health Alliance Commercial |
$11.88
|
|
|
HCHG POTASSIUM-URINE
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
H3011076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG POTASSIUM-URINE
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
H3011076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$33.30
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$36.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.73
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.30
|
| Rate for Payer: University Health Alliance Commercial |
$11.12
|
|
|
HCHG PREALBUMIN
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
H3011078
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: AlohaCare Medicaid |
$108.00
|
| Rate for Payer: AlohaCare Medicare |
$194.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$213.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.59
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Humana Medicare |
$194.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.40
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.40
|
| Rate for Payer: University Health Alliance Commercial |
$37.70
|
|
|
HCHG PREALBUMIN
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
H3011078
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
|
|
HCHG PROCALCITONIN
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
H3011547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$352.75 |
| Max. Negotiated Rate |
$402.55 |
| Rate for Payer: Cash Price |
$269.75
|
| Rate for Payer: Health Management Network Commercial |
$352.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$373.50
|
| Rate for Payer: MDX Hawaii PPO |
$402.55
|
|
|
HCHG PROCALCITONIN
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 84145
|
| Hospital Charge Code |
H3011547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$410.85 |
| Rate for Payer: AlohaCare Medicaid |
$207.50
|
| Rate for Payer: AlohaCare Medicare |
$373.50
|
| Rate for Payer: Cash Price |
$269.75
|
| Rate for Payer: Cash Price |
$269.75
|
| Rate for Payer: Devoted Health Medicare |
$410.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$34.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$352.75
|
| Rate for Payer: Humana Medicare |
$373.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$373.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.50
|
| Rate for Payer: MDX Hawaii PPO |
$402.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.50
|
| Rate for Payer: University Health Alliance Commercial |
$51.36
|
|
|
HCHG PROGESTERONE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
H3011086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
HCHG PROGESTERONE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
H3011086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$150.48 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$136.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$150.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.86
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$136.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$136.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.80
|
| Rate for Payer: University Health Alliance Commercial |
$53.93
|
|
|
HCHG PROINSULIN
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
H3011380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: MDX Hawaii PPO |
$183.33
|
|
|
HCHG PROINSULIN
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
H3011380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$187.11 |
| Rate for Payer: AlohaCare Medicaid |
$94.50
|
| Rate for Payer: AlohaCare Medicare |
$170.10
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Devoted Health Medicare |
$187.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$33.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.69
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Humana Medicare |
$170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.10
|
| Rate for Payer: MDX Hawaii PPO |
$183.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.10
|
| Rate for Payer: University Health Alliance Commercial |
$46.05
|
|
|
HCHG PROLACTIN
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
H3011092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$121.55 |
| Max. Negotiated Rate |
$138.71 |
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.70
|
| Rate for Payer: MDX Hawaii PPO |
$138.71
|
|
|
HCHG PROLACTIN
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
H3011092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$141.57 |
| Rate for Payer: AlohaCare Medicaid |
$71.50
|
| Rate for Payer: AlohaCare Medicare |
$128.70
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Cash Price |
$92.95
|
| Rate for Payer: Devoted Health Medicare |
$141.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.38
|
| Rate for Payer: Health Management Network Commercial |
$121.55
|
| Rate for Payer: Humana Medicare |
$128.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$128.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.70
|
| Rate for Payer: MDX Hawaii PPO |
$138.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.70
|
| Rate for Payer: University Health Alliance Commercial |
$50.10
|
|
|
HCHG PROLONGED IV INF, REQ PUMP
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
H4501166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$625.50
|
| Rate for Payer: AlohaCare Medicare |
$1,125.90
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Devoted Health Medicare |
$1,238.49
|
| 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 |
$1,125.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,188.45
|
| Rate for Payer: Health Management Network Commercial |
$1,063.35
|
| Rate for Payer: Humana Medicare |
$1,125.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,125.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,125.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,213.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,125.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,125.90
|
| Rate for Payer: University Health Alliance Commercial |
$911.85
|
|
|
HCHG PROLONGED IV INF, REQ PUMP
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
H4501166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.35 |
| Max. Negotiated Rate |
$1,213.47 |
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Health Management Network Commercial |
$1,063.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,125.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,213.47
|
|
|
HCHG PROSTATE CANCER SCREEN PSA
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
H3011396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$144.54 |
| Rate for Payer: AlohaCare Medicaid |
$73.00
|
| Rate for Payer: AlohaCare Medicare |
$131.40
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Devoted Health Medicare |
$144.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$131.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$138.70
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Humana Medicare |
$131.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.40
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$131.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$131.40
|
| Rate for Payer: University Health Alliance Commercial |
$106.42
|
|
|
HCHG PROSTATE CANCER SCREEN PSA
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
H3011396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.40
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
HCHG PROSTATIC SPECIFIC AG FREE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
H3020694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| 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 |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| 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 |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.30
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
HCHG PROSTATIC SPECIFIC AG FREE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
H3020694
|
|
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 PROSTATIC SPECIFIC AG SCRN TOTAL
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$270.27 |
| Rate for Payer: AlohaCare Medicaid |
$136.50
|
| Rate for Payer: AlohaCare Medicare |
$245.70
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Devoted Health Medicare |
$270.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Humana Medicare |
$245.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.70
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
HCHG PROSTATIC SPECIFIC AG SCRN TOTAL
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
HCHG PROSTATIC SPECIFIC AG TOTAL
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$270.27 |
| Rate for Payer: AlohaCare Medicaid |
$136.50
|
| Rate for Payer: AlohaCare Medicare |
$245.70
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Devoted Health Medicare |
$270.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Humana Medicare |
$245.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.70
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
HCHG PROSTATIC SPECIFIC AG TOTAL
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$232.05 |
| Max. Negotiated Rate |
$264.81 |
| Rate for Payer: Cash Price |
$177.45
|
| Rate for Payer: Health Management Network Commercial |
$232.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$245.70
|
| Rate for Payer: MDX Hawaii PPO |
$264.81
|
|
|
HCHG PROTEIN 3 AB
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
|
