|
HCHG VANCOMYCIN LEVEL
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
H3011274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
HCHG VARICELLA-ZOSTER AB IGG
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
H3020798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG VARICELLA-ZOSTER AB IGG
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
H3020798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG VARICELLA-ZOSTER AB IGM 90
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
H3020800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$96.03 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
|
|
HCHG VARICELLA-ZOSTER AB IGM 90
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
H3020800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$98.01 |
| Rate for Payer: AlohaCare Medicaid |
$49.50
|
| Rate for Payer: AlohaCare Medicare |
$89.10
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Devoted Health Medicare |
$98.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$84.15
|
| Rate for Payer: Humana Medicare |
$89.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.10
|
| Rate for Payer: MDX Hawaii PPO |
$96.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG VARICELLA-ZOSTER VIRUS, RAPID CULT - 90
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
H3060538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$137.61 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$125.10
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$137.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$125.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.56
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$125.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$125.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$125.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$125.10
|
| Rate for Payer: University Health Alliance Commercial |
$50.54
|
|
|
HCHG VARICELLA-ZOSTER VIRUS, RAPID CULT - 90
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
H3060538
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
HCHG VDRL-CSF
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
H3020802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
HCHG VDRL-CSF
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
H3020802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$29.70
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Devoted Health Medicare |
$32.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.70
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG VENIPUNCTURE 3 YRS OR >, PHYS/QHP SKILL
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
H4501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
HCHG VENIPUNCTURE 3 YRS OR >, PHYS/QHP SKILL
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
H4501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$114.30
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$125.73
|
| 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 |
$114.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.65
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$114.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.30
|
| Rate for Payer: University Health Alliance Commercial |
$92.57
|
|
|
HCHG VENT MGMT SUBSEQUENT DAY
|
Facility
|
OP
|
$1,510.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
H4100283
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$1,494.90 |
| Rate for Payer: AlohaCare Medicaid |
$755.00
|
| Rate for Payer: AlohaCare Medicare |
$1,359.00
|
| Rate for Payer: Cash Price |
$981.50
|
| Rate for Payer: Cash Price |
$981.50
|
| Rate for Payer: Devoted Health Medicare |
$1,494.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$788.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,359.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,434.50
|
| Rate for Payer: Health Management Network Commercial |
$1,283.50
|
| Rate for Payer: Humana Medicare |
$1,359.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,359.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$770.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,359.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,464.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,359.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,359.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,359.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,100.64
|
|
|
HCHG VENT MGMT SUBSEQUENT DAY
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
H4100283
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,283.50 |
| Max. Negotiated Rate |
$1,464.70 |
| Rate for Payer: Cash Price |
$981.50
|
| Rate for Payer: Health Management Network Commercial |
$1,283.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,359.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,464.70
|
|
|
HCHG VIBRIO STOOL CULT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
H3060520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HCHG VIBRIO STOOL CULT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
H3060520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$154.44 |
| Rate for Payer: AlohaCare Medicaid |
$78.00
|
| Rate for Payer: AlohaCare Medicare |
$140.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Devoted Health Medicare |
$154.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: Humana Medicare |
$140.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.40
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.40
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HCHG VIRAL ID TISS CULTURE ADD SO
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
K3060024
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$177.21 |
| Rate for Payer: Devoted Health Medicare |
$177.21
|
| Rate for Payer: AlohaCare Medicaid |
$89.50
|
| Rate for Payer: AlohaCare Medicare |
$161.10
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$161.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.20
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$161.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$161.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$161.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$161.10
|
| Rate for Payer: University Health Alliance Commercial |
$23.18
|
|
|
HCHG VIRAL ID TISS CULTURE ADD SO
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
K3060024
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
HCHG VITAL CAPACITY & NIF
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
H4600150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$685.95 |
| Max. Negotiated Rate |
$782.79 |
| Rate for Payer: Cash Price |
$524.55
|
| Rate for Payer: Health Management Network Commercial |
$685.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$726.30
|
| Rate for Payer: MDX Hawaii PPO |
$782.79
|
|
|
HCHG VITAL CAPACITY & NIF
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
H4600150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$798.93 |
| Rate for Payer: AlohaCare Medicaid |
$403.50
|
| Rate for Payer: AlohaCare Medicare |
$726.30
|
| Rate for Payer: Cash Price |
$524.55
|
| Rate for Payer: Cash Price |
$524.55
|
| Rate for Payer: Devoted Health Medicare |
$798.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$164.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$726.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$766.65
|
| Rate for Payer: Health Management Network Commercial |
$685.95
|
| Rate for Payer: Humana Medicare |
$726.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$726.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$411.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$726.30
|
| Rate for Payer: MDX Hawaii PPO |
$782.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$726.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$726.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$726.30
|
| Rate for Payer: University Health Alliance Commercial |
$588.22
|
|
|
HCHG VITAMIN A 90
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
H3011278
|
|
Hospital Revenue Code
|
301
|
| 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 VITAMIN A 90
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
H3011278
|
|
Hospital Revenue Code
|
301
|
| 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 VITAMIN B1
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
H3011280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
|
|
HCHG VITAMIN B1
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
H3011280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: AlohaCare Medicaid |
$77.00
|
| Rate for Payer: AlohaCare Medicare |
$138.60
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Devoted Health Medicare |
$152.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.23
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Humana Medicare |
$138.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.60
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.60
|
| Rate for Payer: University Health Alliance Commercial |
$49.30
|
|
|
HCHG VITAMIN B-12
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
H3011282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$217.28 |
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
|
|
HCHG VITAMIN B-12
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
H3011282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$221.76 |
| Rate for Payer: AlohaCare Medicaid |
$112.00
|
| Rate for Payer: AlohaCare Medicare |
$201.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Devoted Health Medicare |
$221.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$190.40
|
| Rate for Payer: Humana Medicare |
$201.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$201.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.60
|
| Rate for Payer: MDX Hawaii PPO |
$217.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$201.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.60
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
