|
HCHG GLUCOSE CSF
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
H3010664
|
|
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 PRECISION G
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
H3010668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
HCHG GLUCOSE PRECISION G
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 82962
|
| Hospital Charge Code |
H3010668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$42.30
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Devoted Health Medicare |
$46.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.28
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$42.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.30
|
| Rate for Payer: University Health Alliance Commercial |
$4.68
|
|
|
HCHG GLUCOSE QUANTITATIVE BLOOD
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
H3010656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Health Management Network Commercial |
$50.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
|
|
HCHG GLUCOSE QUANTITATIVE BLOOD
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
H3010656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: AlohaCare Medicaid |
$29.50
|
| Rate for Payer: AlohaCare Medicare |
$53.10
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$58.41
|
| 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 |
$53.10
|
| 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 |
$50.15
|
| Rate for Payer: Humana Medicare |
$53.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.10
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.10
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
HCHG GLUCOSE TOL 3 HR PREG
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
H3010670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HCHG GLUCOSE TOL 3 HR PREG
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
H3010670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$81.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Devoted Health Medicare |
$89.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.87
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$81.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.28
|
|
|
HCHG GLUTAMIC ACID DECARBOXYLASE AB - 90
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
H3001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: AlohaCare Medicaid |
$85.50
|
| Rate for Payer: AlohaCare Medicare |
$153.90
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Devoted Health Medicare |
$169.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Humana Medicare |
$153.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.90
|
| Rate for Payer: MDX Hawaii PPO |
$165.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.90
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
|
|
HCHG GLUTAMIC ACID DECARBOXYLASE AB - 90
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
H3001099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$165.87 |
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Health Management Network Commercial |
$145.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.90
|
| Rate for Payer: MDX Hawaii PPO |
$165.87
|
|
|
HCHG GM1 AB 90
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3020518
|
|
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 GM1 AB 90
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3020518
|
|
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 GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
H3011367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
H3011367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$139.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$126.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM & REFLEX TO QUANT
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
H3011368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HCHG GONADOTROPIN, CHORIONIC (HCG); QUAL, SERUM & REFLEX TO QUANT
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
H3011368
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$126.90
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Cash Price |
$91.65
|
| Rate for Payer: Devoted Health Medicare |
$139.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$126.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.90
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
HCHG GONADOTROPIN, CHORIONIC (HCG); QUANT, SERUM
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
H3010700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$189.55 |
| Max. Negotiated Rate |
$216.31 |
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
|
|
HCHG GONADOTROPIN, CHORIONIC (HCG); QUANT, SERUM
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 84702
|
| Hospital Charge Code |
H3010700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$220.77 |
| Rate for Payer: AlohaCare Medicaid |
$111.50
|
| Rate for Payer: AlohaCare Medicare |
$200.70
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Cash Price |
$144.95
|
| Rate for Payer: Devoted Health Medicare |
$220.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.05
|
| Rate for Payer: Health Management Network Commercial |
$189.55
|
| Rate for Payer: Humana Medicare |
$200.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.70
|
| Rate for Payer: MDX Hawaii PPO |
$216.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.70
|
| Rate for Payer: University Health Alliance Commercial |
$38.91
|
|
|
HCHG GRAM STAIN SMEAR
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
H3060200
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$70.29 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$63.90
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$70.29
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$63.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.90
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
HCHG GRAM STAIN SMEAR
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
H3060200
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HCHG GROWTH HORMONE 90
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
H3010686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.67 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: AlohaCare Medicaid |
$62.50
|
| Rate for Payer: AlohaCare Medicare |
$112.50
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Devoted Health Medicare |
$123.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.67
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Humana Medicare |
$112.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$43.09
|
|
|
HCHG GROWTH HORMONE 90
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
H3010686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
|
|
HCHG HALOPERIDOL (HALDOL) 90
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 80173
|
| Hospital Charge Code |
H3010692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
HCHG HALOPERIDOL (HALDOL) 90
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 80173
|
| Hospital Charge Code |
H3010692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$117.81 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$107.10
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Devoted Health Medicare |
$117.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.78
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Humana Medicare |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.10
|
| Rate for Payer: University Health Alliance Commercial |
$37.63
|
|
|
HCHG HAND (2 VIEWS)
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200424
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.55 |
| 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 |
$17.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$507.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| 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 |
$17.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$507.60
|
| Rate for Payer: University Health Alliance Commercial |
$55.46
|
|
|
HCHG HAND (2 VIEWS)
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
H3200424
|
|
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
|
|
