|
HCHG COVID19 AB IGG QUAL
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
K3020014
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.13 |
| 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 |
$42.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.13
|
| 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 |
$42.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.40
|
| Rate for Payer: University Health Alliance Commercial |
$84.55
|
|
|
HCHG COVID19 AB IGG QUAL
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 86769
|
| Hospital Charge Code |
K3020014
|
|
Hospital Revenue Code
|
302
|
| 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 COVID, FLU AB BY PCR (CEPHIED)
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS 87636
|
| Hospital Charge Code |
H3060815
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$773.19 |
| Rate for Payer: AlohaCare Medicaid |
$390.50
|
| Rate for Payer: AlohaCare Medicare |
$702.90
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Devoted Health Medicare |
$773.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$178.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$702.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$142.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.63
|
| Rate for Payer: Health Management Network Commercial |
$663.85
|
| Rate for Payer: Humana Medicare |
$702.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$398.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$702.90
|
| Rate for Payer: MDX Hawaii PPO |
$757.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$702.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$702.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$702.90
|
| Rate for Payer: University Health Alliance Commercial |
$569.27
|
|
|
HCHG COVID, FLU AB BY PCR (CEPHIED)
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
HCPCS 87636
|
| Hospital Charge Code |
H3060815
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$663.85 |
| Max. Negotiated Rate |
$757.57 |
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Health Management Network Commercial |
$663.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$702.90
|
| Rate for Payer: MDX Hawaii PPO |
$757.57
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020454
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.03
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.67
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020458
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020454
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.03
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.67
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020458
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.03
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.67
|
|
|
HCHG COXSACKIE A AB 7 90
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
H3020456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$90.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$99.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.03
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.67
|
|
|
HCHG C-PEPTIDE 90
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS 84681
|
| Hospital Charge Code |
H3010422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$298.76 |
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: Health Management Network Commercial |
$261.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.20
|
| Rate for Payer: MDX Hawaii PPO |
$298.76
|
|
|
HCHG C-PEPTIDE 90
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS 84681
|
| Hospital Charge Code |
H3010422
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$304.92 |
| Rate for Payer: AlohaCare Medicaid |
$154.00
|
| Rate for Payer: AlohaCare Medicare |
$277.20
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: Cash Price |
$200.20
|
| Rate for Payer: Devoted Health Medicare |
$304.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$261.80
|
| Rate for Payer: Humana Medicare |
$277.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$277.20
|
| Rate for Payer: MDX Hawaii PPO |
$298.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$277.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$277.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$277.20
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
HCHG CPK ISOENZYMES - 90
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
H3011669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: AlohaCare Medicaid |
$51.00
|
| Rate for Payer: AlohaCare Medicare |
$91.80
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Devoted Health Medicare |
$100.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.39
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Humana Medicare |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.80
|
| Rate for Payer: University Health Alliance Commercial |
$34.61
|
|
|
HCHG CPK ISOENZYMES - 90
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
H3011669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.70 |
| Max. Negotiated Rate |
$98.94 |
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Management Network Commercial |
$86.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$98.94
|
|
|
HCHG CPK TOTAL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
H3010424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HCHG CPK TOTAL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
H3010424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$108.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.84
|
|
|
HCHG CPK TOTAL - 90
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
H3011668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: AlohaCare Medicaid |
$60.00
|
| Rate for Payer: AlohaCare Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Humana Medicare |
$108.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.84
|
|
|
HCHG CPK TOTAL - 90
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
H3011668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$116.40
|
|
|
HCHG CPR
|
Facility
|
OP
|
$1,803.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
H4500352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,784.97 |
| Rate for Payer: AlohaCare Medicaid |
$901.50
|
| Rate for Payer: AlohaCare Medicare |
$1,622.70
|
| Rate for Payer: Cash Price |
$1,171.95
|
| Rate for Payer: Cash Price |
$1,171.95
|
| Rate for Payer: Devoted Health Medicare |
$1,784.97
|
| 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 |
$1,622.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,712.85
|
| Rate for Payer: Health Management Network Commercial |
$1,532.55
|
| Rate for Payer: Humana Medicare |
$1,622.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,622.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,622.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,748.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,622.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,622.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,622.70
|
| Rate for Payer: University Health Alliance Commercial |
$1,314.21
|
|
|
HCHG CPR
|
Facility
|
IP
|
$1,803.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
H4500352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,532.55 |
| Max. Negotiated Rate |
$1,748.91 |
| Rate for Payer: Cash Price |
$1,171.95
|
| Rate for Payer: Health Management Network Commercial |
$1,532.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,622.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,748.91
|
|
|
HCHG C-REACTIVE PROTEIN (CRP)
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
H3020474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
|
HCHG C-REACTIVE PROTEIN (CRP)
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86140
|
| Hospital Charge Code |
H3020474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$78.30
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Devoted Health Medicare |
$86.13
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$78.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.30
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HCHG CREATINE CLEARANCE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
H3010428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: AlohaCare Medicaid |
$36.00
|
| Rate for Payer: AlohaCare Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Devoted Health Medicare |
$71.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.46
|
| Rate for Payer: Health Management Network Commercial |
$61.20
|
| Rate for Payer: Humana Medicare |
$64.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.80
|
| Rate for Payer: MDX Hawaii PPO |
$69.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.80
|
| Rate for Payer: University Health Alliance Commercial |
$24.42
|
|
