|
HCHG DRUG SCRN FENTANYL SO
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
|
HCHG DRUG TEST PRSMV DIR OPT OBS
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
H3011824
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| 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 |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| 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 |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$27.68
|
|
|
HCHG DRUG TEST PRSMV DIR OPT OBS
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
H3011824
|
|
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 DRUG TEST(S) PRESUMPTIVE BY INSTRUMENT - 90
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
H3011648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$692.01 |
| Rate for Payer: AlohaCare Medicaid |
$349.50
|
| Rate for Payer: AlohaCare Medicare |
$629.10
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Devoted Health Medicare |
$692.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$629.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Humana Medicare |
$629.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$356.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$629.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$629.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$629.10
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HCHG DRUG TEST(S) PRESUMPTIVE BY INSTRUMENT - 90
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
H3011648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$594.15 |
| Max. Negotiated Rate |
$678.03 |
| Rate for Payer: Cash Price |
$454.35
|
| Rate for Payer: Health Management Network Commercial |
$594.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$629.10
|
| Rate for Payer: MDX Hawaii PPO |
$678.03
|
|
|
HCHG DRVV CONFIRM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
H3050282
|
|
Hospital Revenue Code
|
305
|
| 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 DRVV CONFIRM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
H3050282
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.98 |
| 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 |
$24.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.98
|
| 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 |
$24.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$46.47
|
|
|
HCHG DRVV MIX
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
H3050283
|
|
Hospital Revenue Code
|
305
|
| 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 DRVV MIX
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
H3050283
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| 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 |
$13.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.58
|
| 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 |
$13.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.60
|
| Rate for Payer: University Health Alliance Commercial |
$24.73
|
|
|
HCHG DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
H3200976
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$486.09 |
| Rate for Payer: AlohaCare Medicaid |
$245.50
|
| Rate for Payer: AlohaCare Medicare |
$441.90
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Devoted Health Medicare |
$486.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$93.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$441.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$109.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$466.45
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Humana Medicare |
$441.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$250.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$441.90
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$441.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$441.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$441.90
|
| Rate for Payer: University Health Alliance Commercial |
$357.89
|
|
|
HCHG DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
H3200976
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$417.35 |
| Max. Negotiated Rate |
$476.27 |
| Rate for Payer: Cash Price |
$319.15
|
| Rate for Payer: Health Management Network Commercial |
$417.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$441.90
|
| Rate for Payer: MDX Hawaii PPO |
$476.27
|
|
|
HCHG EBV AB EARLY AG IGG
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
H3020490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$192.06 |
| Rate for Payer: AlohaCare Medicaid |
$97.00
|
| Rate for Payer: AlohaCare Medicare |
$174.60
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Devoted Health Medicare |
$192.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.12
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Humana Medicare |
$174.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.60
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.60
|
| Rate for Payer: University Health Alliance Commercial |
$33.91
|
|
|
HCHG EBV AB EARLY AG IGG
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
H3020490
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$164.90 |
| Max. Negotiated Rate |
$188.18 |
| Rate for Payer: Cash Price |
$126.10
|
| Rate for Payer: Health Management Network Commercial |
$164.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.60
|
| Rate for Payer: MDX Hawaii PPO |
$188.18
|
|
|
HCHG E-B VIRUS AB IGG 90
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
H3020484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$227.80 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
|
|
HCHG E-B VIRUS AB IGG 90
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
H3020484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$265.32 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$241.20
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Devoted Health Medicare |
$265.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.14
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$241.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$241.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.20
|
| Rate for Payer: University Health Alliance Commercial |
$46.90
|
|
|
HCHG E-B VIRUS AB IGM 90
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
H3020486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$227.80 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
|
|
HCHG E-B VIRUS AB IGM 90
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
H3020486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$265.32 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$241.20
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Cash Price |
$174.20
|
| Rate for Payer: Devoted Health Medicare |
$265.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$241.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.14
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$241.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$136.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$241.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$241.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$241.20
|
| Rate for Payer: University Health Alliance Commercial |
$46.90
|
|
|
HCHG E-B VIRUS AB NUC AG 90
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
H3020488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$224.73 |
| Rate for Payer: AlohaCare Medicaid |
$113.50
|
| Rate for Payer: AlohaCare Medicare |
$204.30
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Devoted Health Medicare |
$224.73
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.29
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Humana Medicare |
$204.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$204.30
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.30
|
| Rate for Payer: University Health Alliance Commercial |
$39.55
|
|
|
HCHG E-B VIRUS AB NUC AG 90
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
H3020488
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$192.95 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$204.30
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
|
|
HCHG EKG 12 LEADS, TRACING ONLY
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
H7300107
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$413.82 |
| Rate for Payer: AlohaCare Medicaid |
$209.00
|
| Rate for Payer: AlohaCare Medicare |
$376.20
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Devoted Health Medicare |
$413.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$376.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$397.10
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: Humana Medicare |
$376.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$213.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$376.20
|
| Rate for Payer: MDX Hawaii PPO |
$405.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$376.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$376.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$376.20
|
| Rate for Payer: University Health Alliance Commercial |
$304.68
|
|
|
HCHG EKG 12 LEADS, TRACING ONLY
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
H7300107
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$355.30 |
| Max. Negotiated Rate |
$405.46 |
| Rate for Payer: Cash Price |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$355.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$376.20
|
| Rate for Payer: MDX Hawaii PPO |
$405.46
|
|
|
HCHG ELASTASE PANCREATIC FECAL QUANTITATIVE 90
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 82653
|
| Hospital Charge Code |
H3011707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$149.40
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$164.34
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.97
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$149.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.40
|
| Rate for Payer: University Health Alliance Commercial |
$121.00
|
|
|
HCHG ELASTASE PANCREATIC FECAL QUANTITATIVE 90
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 82653
|
| Hospital Charge Code |
H3011707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
HCHG ELBOW (2 VIEWS)
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
H3200320
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$507.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$558.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$507.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$507.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$507.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$55.57
|
|
|
HCHG ELBOW (2 VIEWS)
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73070
|
| Hospital Charge Code |
H3200320
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
|
