|
HCHG UA (DIPSTICK), NON-AUTOMATED, W/O MICROSCOPY
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
H3070120
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$42.30
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Devoted Health Medicare |
$46.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$42.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.30
|
| Rate for Payer: University Health Alliance Commercial |
$6.60
|
|
|
HCHG UA MICRO REFLEX CULT
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
K3070004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: AlohaCare Medicaid |
$23.00
|
| Rate for Payer: AlohaCare Medicare |
$41.40
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Devoted Health Medicare |
$45.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Humana Medicare |
$41.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.40
|
| Rate for Payer: University Health Alliance Commercial |
$7.84
|
|
|
HCHG UA MICRO REFLEX CULT
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
K3070004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
|
|
HCHG UA QUAL AUTO WO MICRO
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
K3070002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HCHG UA QUAL AUTO WO MICRO
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
K3070002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$37.80
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Devoted Health Medicare |
$41.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$37.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.80
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HCHG UGI TRACT DOUBLE CONTRAST
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
H3201004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$976.65 |
| Max. Negotiated Rate |
$1,114.53 |
| Rate for Payer: Cash Price |
$746.85
|
| Rate for Payer: Health Management Network Commercial |
$976.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,034.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,114.53
|
|
|
HCHG UGI TRACT DOUBLE CONTRAST
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
H3201004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$1,137.51 |
| Rate for Payer: AlohaCare Medicaid |
$574.50
|
| Rate for Payer: AlohaCare Medicare |
$1,034.10
|
| Rate for Payer: Cash Price |
$746.85
|
| Rate for Payer: Cash Price |
$746.85
|
| Rate for Payer: Devoted Health Medicare |
$1,137.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$54.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,034.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$58.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$179.20
|
| Rate for Payer: Health Management Network Commercial |
$976.65
|
| Rate for Payer: Humana Medicare |
$1,034.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,034.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$585.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,034.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,114.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,034.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,034.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,034.10
|
| Rate for Payer: University Health Alliance Commercial |
$237.13
|
|
|
HCHG UGT1A1 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 81350
|
| Hospital Charge Code |
K3100011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$982.60 |
| Max. Negotiated Rate |
$1,121.32 |
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,040.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,121.32
|
|
|
HCHG UGT1A1 GENE ANALYSIS COMMON VARIANTS
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 81350
|
| Hospital Charge Code |
K3100011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$1,144.44 |
| Rate for Payer: AlohaCare Medicaid |
$578.00
|
| Rate for Payer: AlohaCare Medicare |
$1,040.40
|
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Devoted Health Medicare |
$1,144.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$292.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,040.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$65.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$234.00
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Humana Medicare |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$589.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,040.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,121.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,040.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,040.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,040.40
|
| Rate for Payer: University Health Alliance Commercial |
$842.61
|
|
|
HCHG UNLISTED MICROBIOLOGY PROCEDURE - 90
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS 87999
|
| Hospital Charge Code |
H3060770
|
|
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 UNLISTED MICROBIOLOGY PROCEDURE - 90
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS 87999
|
| Hospital Charge Code |
H3060770
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$315.81 |
| Rate for Payer: AlohaCare Medicaid |
$159.50
|
| Rate for Payer: AlohaCare Medicare |
$287.10
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Cash Price |
$207.35
|
| Rate for Payer: Devoted Health Medicare |
$315.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$287.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$303.05
|
| Rate for Payer: Health Management Network Commercial |
$271.15
|
| Rate for Payer: Humana Medicare |
$287.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$287.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$162.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$287.10
|
| Rate for Payer: MDX Hawaii PPO |
$309.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$287.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$287.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$287.10
|
| Rate for Payer: University Health Alliance Commercial |
$232.52
|
|
|
HCHG UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
H4501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,191.70 |
| Max. Negotiated Rate |
$1,359.94 |
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,261.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
|
|
HCHG UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
H4501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$701.00
|
| Rate for Payer: AlohaCare Medicare |
$1,261.80
|
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Cash Price |
$911.30
|
| Rate for Payer: Devoted Health Medicare |
$1,387.98
|
| 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 |
$1,261.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,331.90
|
| Rate for Payer: Health Management Network Commercial |
$1,191.70
|
| Rate for Payer: Humana Medicare |
$1,261.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,261.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,261.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,359.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,261.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,261.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,261.80
|
| Rate for Payer: University Health Alliance Commercial |
$1,021.92
|
|
|
HCHG UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 42999
|
| Hospital Charge Code |
K4500007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$939.25 |
| Max. Negotiated Rate |
$1,071.85 |
| Rate for Payer: Cash Price |
$718.25
|
| Rate for Payer: Health Management Network Commercial |
$939.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$994.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,071.85
|
|
|
HCHG UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
HCPCS 42999
|
| Hospital Charge Code |
K4500007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$552.50
|
| Rate for Payer: AlohaCare Medicare |
$994.50
|
| Rate for Payer: Cash Price |
$718.25
|
| Rate for Payer: Cash Price |
$718.25
|
| Rate for Payer: Devoted Health Medicare |
$1,093.95
|
| 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 |
$994.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,049.75
|
| Rate for Payer: Health Management Network Commercial |
$939.25
|
| Rate for Payer: Humana Medicare |
$994.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$994.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$994.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,071.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$994.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$994.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$994.50
|
| Rate for Payer: University Health Alliance Commercial |
$805.43
|
|
|
HCHG UPPER GI ENDOSCOPY W BIOPSY
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
H4501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG UPPER GI ENDOSCOPY W BIOPSY
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
H4501013
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,267.50
|
| Rate for Payer: AlohaCare Medicare |
$4,081.50
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$4,489.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,081.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,081.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,081.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,081.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG UPP GI ENDO W REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
H4501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,854.75 |
| Max. Negotiated Rate |
$4,398.95 |
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
|
|
HCHG UPP GI ENDO W REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
H4501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$5,160.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,267.50
|
| Rate for Payer: AlohaCare Medicare |
$4,081.50
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Cash Price |
$2,947.75
|
| Rate for Payer: Devoted Health Medicare |
$4,489.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,081.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,308.25
|
| Rate for Payer: Health Management Network Commercial |
$3,854.75
|
| Rate for Payer: Humana Medicare |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,081.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,081.50
|
| Rate for Payer: MDX Hawaii PPO |
$4,398.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,081.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,081.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,081.50
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HCHG UREA NITROGEN
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
H3010296
|
|
Hospital Revenue Code
|
301
|
| 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 UREA NITROGEN
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
H3010296
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| 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 |
$5.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.95
|
| 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 |
$5.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.60
|
| Rate for Payer: University Health Alliance Commercial |
$10.19
|
|
|
HCHG UREA NITROGEN-URINE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
H3011260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HCHG UREA NITROGEN-URINE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
H3011260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$42.57 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$38.70
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Devoted Health Medicare |
$42.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.56
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$38.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.70
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG URETHROCYSTOGRAM *
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
H3200856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$1,250.37 |
| Rate for Payer: AlohaCare Medicaid |
$631.50
|
| Rate for Payer: AlohaCare Medicare |
$1,136.70
|
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Devoted Health Medicare |
$1,250.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,136.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$1,073.55
|
| Rate for Payer: Humana Medicare |
$1,136.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,136.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$644.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,136.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,225.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,136.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,136.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,136.70
|
| Rate for Payer: University Health Alliance Commercial |
$920.60
|
|
|
HCHG URETHROCYSTOGRAM *
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 74450
|
| Hospital Charge Code |
H3200856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,073.55 |
| Max. Negotiated Rate |
$1,225.11 |
| Rate for Payer: Cash Price |
$820.95
|
| Rate for Payer: Health Management Network Commercial |
$1,073.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,136.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,225.11
|
|
