|
HCHG PROTEIN 3 AB
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: AlohaCare Medicaid |
$114.00
|
| Rate for Payer: AlohaCare Medicare |
$205.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Devoted Health Medicare |
$225.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$205.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$193.80
|
| Rate for Payer: Humana Medicare |
$205.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$205.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$116.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$205.20
|
| Rate for Payer: MDX Hawaii PPO |
$221.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$205.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$205.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$205.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.82
|
|
|
HCHG PROTEIN C ACTIVITY
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
H3050210
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$202.95 |
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$184.50
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Devoted Health Medicare |
$202.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.84
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$184.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$184.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.50
|
| Rate for Payer: University Health Alliance Commercial |
$35.74
|
|
|
HCHG PROTEIN C ACTIVITY
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
H3050210
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
HCHG PROTEIN C ANTIGEN
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
H3050208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG PROTEIN C ANTIGEN
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
H3050208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.01
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$31.08
|
|
|
HCHG PROTEIN C RESISTANCE ACTIVATED
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
H3050212
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
|
|
HCHG PROTEIN C RESISTANCE ACTIVATED
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
H3050212
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$114.84 |
| Rate for Payer: AlohaCare Medicaid |
$58.00
|
| Rate for Payer: AlohaCare Medicare |
$104.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Devoted Health Medicare |
$114.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.32
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Humana Medicare |
$104.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.40
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.40
|
| Rate for Payer: University Health Alliance Commercial |
$39.61
|
|
|
HCHG PROTEIN-CSF
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
H3011110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
|
|
HCHG PROTEIN-CSF
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
H3011110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicare |
$27.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Devoted Health Medicare |
$29.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.00
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HCHG PROTEIN ELECTROPHORESIS
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
H3011686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: AlohaCare Medicaid |
$64.50
|
| Rate for Payer: AlohaCare Medicare |
$116.10
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Devoted Health Medicare |
$127.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Humana Medicare |
$116.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$94.03
|
|
|
HCHG PROTEIN ELECTROPHORESIS
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83521
|
| Hospital Charge Code |
H3011686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$125.13 |
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
|
|
HCHG PROTEIN ELP SERUM
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
H3011102
|
|
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 PROTEIN ELP SERUM
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
H3011102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| 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 |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| 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 |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HCHG PROTEIN ELP URINE
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
H3011104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: AlohaCare Medicaid |
$66.00
|
| Rate for Payer: AlohaCare Medicare |
$118.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Devoted Health Medicare |
$130.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.83
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Humana Medicare |
$118.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.80
|
| Rate for Payer: University Health Alliance Commercial |
$46.10
|
|
|
HCHG PROTEIN ELP URINE
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
H3011104
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Health Management Network Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.80
|
| Rate for Payer: MDX Hawaii PPO |
$128.04
|
|
|
HCHG PROTEIN S ACTIVITY
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
H3050216
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$114.84 |
| Rate for Payer: AlohaCare Medicaid |
$58.00
|
| Rate for Payer: AlohaCare Medicare |
$104.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Devoted Health Medicare |
$114.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.32
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Humana Medicare |
$104.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.40
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.40
|
| Rate for Payer: University Health Alliance Commercial |
$39.61
|
|
|
HCHG PROTEIN S ACTIVITY
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 85306
|
| Hospital Charge Code |
H3050216
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
|
|
HCHG PROTEIN S TOTAL
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
H3050214
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
|
HCHG PROTEIN S TOTAL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 85305
|
| Hospital Charge Code |
H3050214
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$79.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$87.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.61
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$79.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.20
|
| Rate for Payer: University Health Alliance Commercial |
$29.97
|
|
|
HCHG PROTEIN TOT
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
H3011106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$27.16 |
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.20
|
| Rate for Payer: MDX Hawaii PPO |
$27.16
|
|
|
HCHG PROTEIN TOT
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
H3011106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$27.72 |
| Rate for Payer: AlohaCare Medicaid |
$14.00
|
| Rate for Payer: AlohaCare Medicare |
$25.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Devoted Health Medicare |
$27.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: Humana Medicare |
$25.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.20
|
| Rate for Payer: MDX Hawaii PPO |
$27.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.20
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HCHG PROTEIN TOT BODY FLUID
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
H3011108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
|
|
HCHG PROTEIN TOT BODY FLUID
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
H3011108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicare |
$27.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Devoted Health Medicare |
$29.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.00
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HCHG PROTHROMBIN TIME
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
H3050218
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$53.10
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$58.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.29
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Humana Medicare |
$53.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.10
|
| Rate for Payer: University Health Alliance Commercial |
$10.16
|
|
|
HCHG PROTHROMBIN TIME
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
H3050218
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
|
