|
HCHG GATED WALL EF/WM/EX SINGLE STUDY
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 78472
|
| Hospital Charge Code |
H3410172
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,188.32 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$197.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,917.60
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,421.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,150.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,188.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$553.93
|
|
|
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 |
$224.07 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| 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 |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$145.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| 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: MDX Hawaii PPO |
$224.07
|
|
|
HCHG GD1B AB 90
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3020516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: AlohaCare Medicaid |
$17.27
|
| Rate for Payer: AlohaCare Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$19.00
|
| 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 |
$17.27
|
| 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 |
$136.00
|
| Rate for Payer: Humana Medicare |
$17.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.27
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.27
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
HCHG GD1B AB 90
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
H3020516
|
|
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: MDX Hawaii PPO |
$155.20
|
|
|
HCHG GENERAL HEALTH PANEL
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
K3010001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.19 |
| Max. Negotiated Rate |
$435.53 |
| Rate for Payer: Cash Price |
$291.85
|
| Rate for Payer: Cash Price |
$291.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$41.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$426.55
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$282.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$228.99
|
| Rate for Payer: MDX Hawaii PPO |
$435.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.19
|
| Rate for Payer: University Health Alliance Commercial |
$92.74
|
|
|
HCHG GENERAL HEALTH PANEL
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
K3010001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$381.65 |
| Max. Negotiated Rate |
$435.53 |
| Rate for Payer: Cash Price |
$291.85
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: MDX Hawaii PPO |
$435.53
|
|
|
HCHG GENTAMICIN LEVEL RIA
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
H3010646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$215.34 |
| Rate for Payer: AlohaCare Medicaid |
$16.38
|
| Rate for Payer: AlohaCare Medicare |
$16.38
|
| Rate for Payer: Cash Price |
$144.30
|
| Rate for Payer: Cash Price |
$144.30
|
| Rate for Payer: Devoted Health Medicare |
$18.02
|
| 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 |
$16.38
|
| 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 |
$188.70
|
| Rate for Payer: Humana Medicare |
$16.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.38
|
| Rate for Payer: MDX Hawaii PPO |
$215.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.38
|
| Rate for Payer: University Health Alliance Commercial |
$42.37
|
|
|
HCHG GENTAMICIN LEVEL RIA
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
H3010646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$188.70 |
| Max. Negotiated Rate |
$215.34 |
| Rate for Payer: Cash Price |
$144.30
|
| Rate for Payer: Health Management Network Commercial |
$188.70
|
| Rate for Payer: MDX Hawaii PPO |
$215.34
|
|
|
HCHG GHB UR SCRN/CONF SO
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$643.11 |
| Rate for Payer: Cash Price |
$430.95
|
| Rate for Payer: Health Management Network Commercial |
$563.55
|
| Rate for Payer: MDX Hawaii PPO |
$643.11
|
|
|
HCHG GHB UR SCRN/CONF SO
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
K3010009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$643.11 |
| Rate for Payer: AlohaCare Medicaid |
$62.14
|
| Rate for Payer: AlohaCare Medicare |
$62.14
|
| Rate for Payer: Cash Price |
$430.95
|
| Rate for Payer: Cash Price |
$430.95
|
| Rate for Payer: Devoted Health Medicare |
$68.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$563.55
|
| Rate for Payer: Humana Medicare |
$62.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$417.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$338.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.14
|
| Rate for Payer: MDX Hawaii PPO |
$643.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.14
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HCHG GIARDIA ANTIGEN EIA
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
K3060028
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
HCHG GIARDIA ANTIGEN EIA
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
K3060028
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$11.98
|
| Rate for Payer: AlohaCare Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$13.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.98
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.98
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
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 |
$100.88 |
| Rate for Payer: AlohaCare Medicaid |
$13.61
|
| Rate for Payer: AlohaCare Medicare |
$13.61
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$14.97
|
| 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 |
$13.61
|
| 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 |
$13.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.61
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.61
|
| 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: MDX Hawaii PPO |
$100.88
|
|
|
HCHG GI BLEED SCAN
|
Facility
|
IP
|
$2,149.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
H3410178
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,826.65 |
| Max. Negotiated Rate |
$2,084.53 |
| Rate for Payer: Cash Price |
$1,396.85
|
| Rate for Payer: Health Management Network Commercial |
$1,826.65
|
| Rate for Payer: MDX Hawaii PPO |
$2,084.53
|
|
|
HCHG GI BLEED SCAN
|
Facility
|
OP
|
$2,149.00
|
|
|
Service Code
|
HCPCS 78278
|
| Hospital Charge Code |
H3410178
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$160.53 |
| Max. Negotiated Rate |
$2,084.53 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,396.85
|
| Rate for Payer: Cash Price |
$1,396.85
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$160.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$174.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,826.65
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,353.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,095.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$2,084.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$160.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$591.91
|
|
|
HCHG GLIADIN DEAMIDATE AB
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
H3021042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$12.05
|
| Rate for Payer: AlohaCare Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$13.26
|
| 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 |
$12.05
|
| 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 |
$126.65
|
| Rate for Payer: Humana Medicare |
$12.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.05
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.05
|
| Rate for Payer: University Health Alliance Commercial |
$108.61
|
|
|
HCHG GLIADIN DEAMIDATE AB
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86258
|
| Hospital Charge Code |
H3021042
|
|
Hospital Revenue Code
|
302
|
| 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: MDX Hawaii PPO |
$144.53
|
|
|
HCHG GLOMERULAR BASE MEM AB SO
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Devoted Health Medicare |
$12.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.53
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network Commercial |
$198.90
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$226.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.53
|
| Rate for Payer: University Health Alliance Commercial |
$29.82
|
|
|
HCHG GLOMERULAR BASE MEM AB SO
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Health Management Network Commercial |
$198.90
|
| Rate for Payer: MDX Hawaii PPO |
$226.98
|
|
|
HCHG GLUCOSE 1 HR POST GLUCOLA
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3011664
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$57.23 |
| Rate for Payer: AlohaCare Medicaid |
$4.75
|
| Rate for Payer: AlohaCare Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Devoted Health Medicare |
$5.22
|
| 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 |
$4.75
|
| 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 |
$50.15
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.75
|
| Rate for Payer: MDX Hawaii PPO |
$57.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.75
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG GLUCOSE 1 HR POST GLUCOLA
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3011664
|
|
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: MDX Hawaii PPO |
$57.23
|
|
|
HCHG GLUCOSE 2 HR POST GLUCOLA
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3010660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
|
|
HCHG GLUCOSE 2 HR POST GLUCOLA
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
H3010660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: AlohaCare Medicaid |
$4.75
|
| Rate for Payer: AlohaCare Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Devoted Health Medicare |
$5.22
|
| 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 |
$4.75
|
| 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 |
$46.75
|
| Rate for Payer: Humana Medicare |
$4.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.75
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.75
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
