|
HCHG FOREARM PORT 2 VIEWS
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
H3200414
|
|
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
|
|
|
HCHG FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
H4501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,198.50 |
| Max. Negotiated Rate |
$1,367.70 |
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
|
|
HCHG FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 54450
|
| Hospital Charge Code |
H4501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$705.00
|
| Rate for Payer: AlohaCare Medicare |
$1,269.00
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Devoted Health Medicare |
$1,395.90
|
| 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 |
$1,269.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,339.50
|
| Rate for Payer: Health Management Network Commercial |
$1,198.50
|
| Rate for Payer: Humana Medicare |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,269.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,269.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,367.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,269.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,269.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,269.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,027.75
|
|
|
HCHG FSH LEVEL
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
H3010624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.58 |
| Max. Negotiated Rate |
$136.62 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicare |
$124.20
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Devoted Health Medicare |
$136.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$124.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.58
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$124.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$124.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$124.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$124.20
|
| Rate for Payer: University Health Alliance Commercial |
$48.04
|
|
|
HCHG FSH LEVEL
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 83001
|
| Hospital Charge Code |
H3010624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$133.86 |
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
|
|
HCHG FTA ABSORPTION 90
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
H3020514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
HCHG FTA ABSORPTION 90
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 86780
|
| Hospital Charge Code |
H3020514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$99.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.97
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$90.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.90
|
| Rate for Payer: University Health Alliance Commercial |
$35.09
|
|
|
HCHG FUNGAL AB ADDL
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
H3020899
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$92.07 |
| Rate for Payer: AlohaCare Medicaid |
$46.50
|
| Rate for Payer: AlohaCare Medicare |
$83.70
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Devoted Health Medicare |
$92.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.25
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Humana Medicare |
$83.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.70
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.70
|
| Rate for Payer: University Health Alliance Commercial |
$31.69
|
|
|
HCHG FUNGAL AB ADDL
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
H3020899
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
|
|
HCHG FUNGAL AB INITIAL
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
H3020898
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
|
|
HCHG FUNGAL AB INITIAL
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
H3020898
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$92.07 |
| Rate for Payer: AlohaCare Medicaid |
$46.50
|
| Rate for Payer: AlohaCare Medicare |
$83.70
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Devoted Health Medicare |
$92.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.25
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Humana Medicare |
$83.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.70
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.70
|
| Rate for Payer: University Health Alliance Commercial |
$31.69
|
|
|
HCHG FUNGAL ID YEAST
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
H3060188
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$189.09 |
| Rate for Payer: AlohaCare Medicaid |
$95.50
|
| Rate for Payer: AlohaCare Medicare |
$171.90
|
| Rate for Payer: Cash Price |
$124.15
|
| Rate for Payer: Cash Price |
$124.15
|
| Rate for Payer: Devoted Health Medicare |
$189.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$162.35
|
| Rate for Payer: Humana Medicare |
$171.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$171.90
|
| Rate for Payer: MDX Hawaii PPO |
$185.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.90
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
HCHG FUNGAL ID YEAST
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
H3060188
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.35 |
| Max. Negotiated Rate |
$185.27 |
| Rate for Payer: Cash Price |
$124.15
|
| Rate for Payer: Health Management Network Commercial |
$162.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.90
|
| Rate for Payer: MDX Hawaii PPO |
$185.27
|
|
|
HCHG FUNGITELL (1-3)-B-D-GLUCAN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 85130
|
| Hospital Charge Code |
H3011660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$82.17 |
| Rate for Payer: AlohaCare Medicaid |
$41.50
|
| Rate for Payer: AlohaCare Medicare |
$74.70
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Devoted Health Medicare |
$82.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.89
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Humana Medicare |
$74.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.70
|
| Rate for Payer: MDX Hawaii PPO |
$80.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.70
|
| Rate for Payer: University Health Alliance Commercial |
$30.75
|
|
|
HCHG FUNGITELL (1-3)-B-D-GLUCAN
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 85130
|
| Hospital Charge Code |
H3011660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$80.51 |
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Health Management Network Commercial |
$70.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$74.70
|
| Rate for Payer: MDX Hawaii PPO |
$80.51
|
|
|
HCHG FUNGITELL, SERUM - 90
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
H3060776
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
|
|
HCHG FUNGITELL, SERUM - 90
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
H3060776
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$311.85 |
| Rate for Payer: AlohaCare Medicaid |
$157.50
|
| Rate for Payer: AlohaCare Medicare |
$283.50
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Devoted Health Medicare |
$311.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$283.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Humana Medicare |
$283.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$283.50
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$283.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$283.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG FUNGUS CULTURE, HAIR/NAIL/SKIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
H3060620
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
HCHG FUNGUS CULTURE, HAIR/NAIL/SKIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
H3060620
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$112.86 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$102.60
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$112.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.71
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$102.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.60
|
| Rate for Payer: University Health Alliance Commercial |
$19.92
|
|
|
HCHG FUNGUS STAIN BY CALCOFLUOR WHITE
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
H3060658
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$90.09 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$81.90
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$90.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.90
|
| Rate for Payer: University Health Alliance Commercial |
$13.88
|
|
|
HCHG FUNGUS STAIN BY CALCOFLUOR WHITE
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
H3060658
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
HCHG G6PD 90
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
H3010626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
|
|
HCHG G6PD 90
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 82955
|
| Hospital Charge Code |
H3010626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: AlohaCare Medicaid |
$37.50
|
| Rate for Payer: AlohaCare Medicare |
$67.50
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Devoted Health Medicare |
$74.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.70
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Humana Medicare |
$67.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.50
|
| Rate for Payer: University Health Alliance Commercial |
$25.07
|
|
|
HCHG GABAPENTIN
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 80171
|
| Hospital Charge Code |
H3010630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$156.42 |
| Rate for Payer: AlohaCare Medicaid |
$79.00
|
| Rate for Payer: AlohaCare Medicare |
$142.20
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Devoted Health Medicare |
$156.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.67
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Humana Medicare |
$142.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.20
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.20
|
| Rate for Payer: University Health Alliance Commercial |
$115.17
|
|
|
HCHG GABAPENTIN
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 80171
|
| Hospital Charge Code |
H3010630
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$153.26 |
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.20
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
|
