|
HCHG ISLET CELL AB SCRN RFX TO TITER
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
H3020624
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: AlohaCare Medicaid |
$96.00
|
| Rate for Payer: AlohaCare Medicare |
$172.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$190.08
|
| 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 |
$172.80
|
| 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 |
$163.20
|
| Rate for Payer: Humana Medicare |
$172.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.80
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.80
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
|
|
HCHG ISLET CELL AB SCRN RFX TO TITER
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
H3020624
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.80
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
|
|
HCHG ISLET CELL AB SO
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
K3020007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: AlohaCare Medicaid |
$96.00
|
| Rate for Payer: AlohaCare Medicare |
$172.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Devoted Health Medicare |
$190.08
|
| 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 |
$172.80
|
| 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 |
$163.20
|
| Rate for Payer: Humana Medicare |
$172.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$172.80
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.80
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
|
|
HCHG ISLET CELL AB SO
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 86341
|
| Hospital Charge Code |
K3020007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Management Network Commercial |
$163.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$172.80
|
| Rate for Payer: MDX Hawaii PPO |
$186.24
|
|
|
HCHG ISOLATION ACID FAST
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
H3060300
|
|
Hospital Revenue Code
|
306
|
| 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 ISOLATION ACID FAST
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
H3060300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.80 |
| 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 |
$13.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.80
|
| 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 |
$13.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.70
|
| Rate for Payer: University Health Alliance Commercial |
$25.49
|
|
|
HCHG ISTAT ABG
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3010804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: AlohaCare Medicaid |
$90.00
|
| Rate for Payer: AlohaCare Medicare |
$162.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Devoted Health Medicare |
$178.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Humana Medicare |
$162.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$162.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$162.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HCHG ISTAT ABG
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
H3010804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Health Management Network Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$162.00
|
| Rate for Payer: MDX Hawaii PPO |
$174.60
|
|
|
HCHG ISTAT- LACTATE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
H3011312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
|
|
HCHG ISTAT- LACTATE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
H3011312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$144.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$158.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.00
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.60
|
|
|
HCHG IV INFUS ADDL SEQ INFUS UP TO 1 HR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
H4500865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$160.00
|
| Rate for Payer: AlohaCare Medicare |
$288.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Devoted Health Medicare |
$316.80
|
| 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 |
$288.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$304.00
|
| Rate for Payer: Health Management Network Commercial |
$272.00
|
| Rate for Payer: Humana Medicare |
$288.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.00
|
| Rate for Payer: MDX Hawaii PPO |
$310.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$288.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$288.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$288.00
|
| Rate for Payer: University Health Alliance Commercial |
$233.25
|
|
|
HCHG IV INFUS ADDL SEQ INFUS UP TO 1 HR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
H4500865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.00 |
| Max. Negotiated Rate |
$310.40 |
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Management Network Commercial |
$272.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.00
|
| Rate for Payer: MDX Hawaii PPO |
$310.40
|
|
|
HCHG IV INFUS CONCURRENT INFUS
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
H4500866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$134.10
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$147.51
|
| 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 |
$134.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$141.55
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$134.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.10
|
| Rate for Payer: University Health Alliance Commercial |
$108.61
|
|
|
HCHG IV INFUS CONCURRENT INFUS
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
H4500866
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
HCHG IV INFUSION EA ADDL PUSH
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
H9400137
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
|
|
HCHG IV INFUSION EA ADDL PUSH
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 96375
|
| Hospital Charge Code |
H9400137
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: AlohaCare Medicaid |
$184.00
|
| Rate for Payer: AlohaCare Medicare |
$331.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Devoted Health Medicare |
$364.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$331.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.60
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Humana Medicare |
$331.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$331.20
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$331.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$331.20
|
| Rate for Payer: University Health Alliance Commercial |
$268.24
|
|
|
HCHG IV INFUSION HYDRATION 1ST HR
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
H2600116
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$1,238.49 |
| Rate for Payer: AlohaCare Medicaid |
$625.50
|
| Rate for Payer: AlohaCare Medicare |
$1,125.90
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Devoted Health Medicare |
$1,238.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$271.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,125.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,188.45
|
| Rate for Payer: Health Management Network Commercial |
$1,063.35
|
| Rate for Payer: Humana Medicare |
$1,125.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,125.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$638.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,125.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,213.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,125.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,125.90
|
| Rate for Payer: University Health Alliance Commercial |
$911.85
|
|
|
HCHG IV INFUSION HYDRATION 1ST HR
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
H4500863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$625.50
|
| Rate for Payer: AlohaCare Medicare |
$1,125.90
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Devoted Health Medicare |
$1,238.49
|
| 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 |
$1,125.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,188.45
|
| Rate for Payer: Health Management Network Commercial |
$1,063.35
|
| Rate for Payer: Humana Medicare |
$1,125.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,125.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,125.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,213.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,125.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,125.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,125.90
|
| Rate for Payer: University Health Alliance Commercial |
$911.85
|
|
|
HCHG IV INFUSION HYDRATION 1ST HR
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
H4500863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.35 |
| Max. Negotiated Rate |
$1,213.47 |
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Health Management Network Commercial |
$1,063.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,125.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,213.47
|
|
|
HCHG IV INFUSION HYDRATION 1ST HR
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
H2600116
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1,063.35 |
| Max. Negotiated Rate |
$1,213.47 |
| Rate for Payer: Cash Price |
$813.15
|
| Rate for Payer: Health Management Network Commercial |
$1,063.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,125.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,213.47
|
|
|
HCHG IV INFUSION HYDRATION EA ADDL HR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
H4501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$294.88 |
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.60
|
| Rate for Payer: MDX Hawaii PPO |
$294.88
|
|
|
HCHG IV INFUSION HYDRATION EA ADDL HR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
H4501024
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$152.00
|
| Rate for Payer: AlohaCare Medicare |
$273.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Devoted Health Medicare |
$300.96
|
| 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 |
$273.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.80
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Humana Medicare |
$273.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.60
|
| Rate for Payer: MDX Hawaii PPO |
$294.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$273.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$273.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.60
|
| Rate for Payer: University Health Alliance Commercial |
$221.59
|
|
|
HCHG IV INFUSION HYDRATION EA ADDL HR
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
H2600118
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: AlohaCare Medicaid |
$152.00
|
| Rate for Payer: AlohaCare Medicare |
$273.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Devoted Health Medicare |
$300.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$59.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.80
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Humana Medicare |
$273.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.60
|
| Rate for Payer: MDX Hawaii PPO |
$294.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$273.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$273.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.60
|
| Rate for Payer: University Health Alliance Commercial |
$221.59
|
|
|
HCHG IV INFUSION HYDRATION EA ADDL HR
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
H2600118
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$294.88 |
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.60
|
| Rate for Payer: MDX Hawaii PPO |
$294.88
|
|
|
HCHG IV INFUSION HYDRATION EA ADDL HR (IN ED)
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
H4500864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$152.00
|
| Rate for Payer: AlohaCare Medicare |
$273.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Devoted Health Medicare |
$300.96
|
| 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 |
$273.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$288.80
|
| Rate for Payer: Health Management Network Commercial |
$258.40
|
| Rate for Payer: Humana Medicare |
$273.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.60
|
| Rate for Payer: MDX Hawaii PPO |
$294.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$273.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$273.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.60
|
| Rate for Payer: University Health Alliance Commercial |
$221.59
|
|
