|
HCHG GAMMA GT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
H3010632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
HCHG GAMMA GT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 82977
|
| Hospital Charge Code |
H3010632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$55.44 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$50.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Devoted Health Medicare |
$55.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$50.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.40
|
| Rate for Payer: University Health Alliance Commercial |
$18.61
|
|
|
HCHG GARNERELLA VAG, DIRECT PROBE
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
H3060677
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$294.03 |
| Rate for Payer: AlohaCare Medicaid |
$148.50
|
| Rate for Payer: AlohaCare Medicare |
$267.30
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Devoted Health Medicare |
$294.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$267.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Humana Medicare |
$267.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$267.30
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$267.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$267.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$267.30
|
| Rate for Payer: University Health Alliance Commercial |
$51.84
|
|
|
HCHG GARNERELLA VAG, DIRECT PROBE
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
H3060677
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$252.45 |
| Max. Negotiated Rate |
$288.09 |
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
|
|
HCHG GASTRIN 90
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
H3010638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: AlohaCare Medicaid |
$65.50
|
| Rate for Payer: AlohaCare Medicare |
$117.90
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Devoted Health Medicare |
$129.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$25.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.63
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Humana Medicare |
$117.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.90
|
| Rate for Payer: University Health Alliance Commercial |
$45.58
|
|
|
HCHG GASTRIN 90
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 82941
|
| Hospital Charge Code |
H3010638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$127.07 |
| Rate for Payer: Cash Price |
$85.15
|
| Rate for Payer: Health Management Network Commercial |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.90
|
| Rate for Payer: MDX Hawaii PPO |
$127.07
|
|
|
HCHG GC PCR
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
H3060190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$228.69 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$207.90
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$228.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$207.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Humana Medicare |
$207.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$207.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$207.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$207.90
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HCHG GC PCR
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 87591
|
| Hospital Charge Code |
H3060190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
|
|
HCHG GD1B AB 90
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3020516
|
|
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 GD1B AB 90
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3020516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| 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 |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| 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 |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG GENTAMICIN LEVEL RIA
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
H3010646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
|
|
HCHG GENTAMICIN LEVEL RIA
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
H3010646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$239.58 |
| Rate for Payer: AlohaCare Medicaid |
$121.00
|
| Rate for Payer: AlohaCare Medicare |
$217.80
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Devoted Health Medicare |
$239.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$217.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.38
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Humana Medicare |
$217.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$217.80
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$217.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$217.80
|
| Rate for Payer: University Health Alliance Commercial |
$42.37
|
|
|
HCHG GIARDIA LAMBLIA AG TEST DFA
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
H3060192
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$93.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$102.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.61
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$93.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.60
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
HCHG GIARDIA LAMBLIA AG TEST DFA
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 87269
|
| Hospital Charge Code |
H3060192
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HCHG GLIADIN DEAMIDATE AB
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
H3021042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$82.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$91.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$82.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.80
|
| Rate for Payer: University Health Alliance Commercial |
$67.06
|
|
|
HCHG GLIADIN DEAMIDATE AB
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
H3021042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HCHG GLUCOSE 1 HR POST GLUCOLA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3011664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$33.30
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$36.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.30
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG GLUCOSE 1 HR POST GLUCOLA
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3011664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG GLUCOSE 2 HR POST GLUCOLA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3010660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$33.30
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$36.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.30
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG GLUCOSE 2 HR POST GLUCOLA
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3010660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG GLUCOSE 2HR PP ONLY
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3010662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$33.30
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$36.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$33.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.30
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG GLUCOSE 2HR PP ONLY
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3010662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HCHG GLUCOSE-BODY FLD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
H3010676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
|
|
HCHG GLUCOSE-BODY FLD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
H3010676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicare |
$27.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Devoted Health Medicare |
$29.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.00
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
HCHG GLUCOSE CSF
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
H3010664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicare |
$27.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Devoted Health Medicare |
$29.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Humana Medicare |
$27.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.00
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
