|
HCHG PROINSULIN
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
H3011380
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
|
HCHG PROLACTIN
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
H3011092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$318.16 |
| Rate for Payer: Cash Price |
$213.20
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: MDX Hawaii PPO |
$318.16
|
|
|
HCHG PROLACTIN
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
H3011092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$318.16 |
| Rate for Payer: AlohaCare Medicaid |
$19.38
|
| Rate for Payer: AlohaCare Medicare |
$19.38
|
| Rate for Payer: Cash Price |
$213.20
|
| Rate for Payer: Cash Price |
$213.20
|
| Rate for Payer: Devoted Health Medicare |
$21.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.38
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: Humana Medicare |
$19.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.38
|
| Rate for Payer: MDX Hawaii PPO |
$318.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.38
|
| Rate for Payer: University Health Alliance Commercial |
$50.10
|
|
|
HCHG PROLONGED IV INF, REQ PUMP
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
H9400149
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$1,028.20 |
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Health Management Network Commercial |
$901.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,028.20
|
|
|
HCHG PROLONGED IV INF, REQ PUMP
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
H4501166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$251.28
|
| Rate for Payer: AlohaCare Medicare |
$251.28
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Devoted Health Medicare |
$276.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$560.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$251.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$520.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,007.00
|
| Rate for Payer: Health Management Network Commercial |
$901.00
|
| Rate for Payer: Humana Medicare |
$251.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.28
|
| Rate for Payer: MDX Hawaii PPO |
$1,028.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$276.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$251.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$251.28
|
| Rate for Payer: University Health Alliance Commercial |
$772.63
|
|
|
HCHG PROLONGED IV INF, REQ PUMP
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
H4501166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$901.00 |
| Max. Negotiated Rate |
$1,028.20 |
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Health Management Network Commercial |
$901.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,028.20
|
|
|
HCHG PROLONGED IV INF, REQ PUMP
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
H9400149
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$248.77 |
| Max. Negotiated Rate |
$1,028.20 |
| Rate for Payer: AlohaCare Medicaid |
$251.28
|
| Rate for Payer: AlohaCare Medicare |
$251.28
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Cash Price |
$689.00
|
| Rate for Payer: Devoted Health Medicare |
$276.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$314.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$251.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,007.00
|
| Rate for Payer: Health Management Network Commercial |
$901.00
|
| Rate for Payer: Humana Medicare |
$251.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$667.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$540.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$251.28
|
| Rate for Payer: MDX Hawaii PPO |
$1,028.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$276.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$251.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$248.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$251.28
|
| Rate for Payer: University Health Alliance Commercial |
$772.63
|
|
|
HCHG PROSTATIC SPECIFIC AG FREE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
H3020694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: AlohaCare Medicaid |
$18.39
|
| Rate for Payer: AlohaCare Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Devoted Health Medicare |
$20.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.39
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.39
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
HCHG PROSTATIC SPECIFIC AG FREE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
H3020694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$192.95 |
| Max. Negotiated Rate |
$220.19 |
| Rate for Payer: Cash Price |
$147.55
|
| Rate for Payer: Health Management Network Commercial |
$192.95
|
| Rate for Payer: MDX Hawaii PPO |
$220.19
|
|
|
HCHG PROSTATIC SPECIFIC AG SCRN TOTAL
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.39
|
| Rate for Payer: AlohaCare Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$20.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.39
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.39
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
HCHG PROSTATIC SPECIFIC AG SCRN TOTAL
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
|
|
HCHG PROSTATIC SPECIFIC AG TOTAL
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: AlohaCare Medicaid |
$18.39
|
| Rate for Payer: AlohaCare Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$20.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$18.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.39
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.39
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
HCHG PROSTATIC SPECIFIC AG TOTAL
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
H3011098
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
|
|
HCHG PROTEIN 3 AB
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: AlohaCare Medicaid |
$11.53
|
| Rate for Payer: AlohaCare Medicare |
$11.53
|
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Cash Price |
$101.40
|
| 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 |
$132.60
|
| Rate for Payer: Humana Medicare |
$11.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
| 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 PROTEIN 3 AB
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
K3010037
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$151.32 |
| Rate for Payer: Cash Price |
$101.40
|
| Rate for Payer: Health Management Network Commercial |
$132.60
|
| Rate for Payer: MDX Hawaii PPO |
$151.32
|
|
|
HCHG PROTEIN C ACTIVITY
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
H3050210
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: AlohaCare Medicaid |
$13.84
|
| Rate for Payer: AlohaCare Medicare |
$13.84
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Devoted Health Medicare |
$15.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.84
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: Humana Medicare |
$13.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$86.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.84
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.84
|
| Rate for Payer: University Health Alliance Commercial |
$35.74
|
|
|
HCHG PROTEIN C ACTIVITY
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 85303
|
| Hospital Charge Code |
H3050210
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Cash Price |
$110.50
|
| Rate for Payer: Health Management Network Commercial |
$144.50
|
| Rate for Payer: MDX Hawaii PPO |
$164.90
|
|
|
HCHG PROTEIN C ANTIGEN
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
H3050208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
|
|
HCHG PROTEIN C ANTIGEN
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 85302
|
| Hospital Charge Code |
H3050208
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$103.79 |
| Rate for Payer: AlohaCare Medicaid |
$12.01
|
| Rate for Payer: AlohaCare Medicare |
$12.01
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Cash Price |
$69.55
|
| Rate for Payer: Devoted Health Medicare |
$13.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.01
|
| Rate for Payer: Health Management Network Commercial |
$90.95
|
| Rate for Payer: Humana Medicare |
$12.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.01
|
| Rate for Payer: MDX Hawaii PPO |
$103.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.01
|
| Rate for Payer: University Health Alliance Commercial |
$31.08
|
|
|
HCHG PROTEIN C RESISTANCE ACTIVATED
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
H3050212
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: AlohaCare Medicaid |
$15.32
|
| Rate for Payer: AlohaCare Medicare |
$15.32
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Devoted Health Medicare |
$16.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.32
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: Humana Medicare |
$15.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.32
|
| Rate for Payer: MDX Hawaii PPO |
$183.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.32
|
| Rate for Payer: University Health Alliance Commercial |
$39.61
|
|
|
HCHG PROTEIN C RESISTANCE ACTIVATED
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 85307
|
| Hospital Charge Code |
H3050212
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$160.65 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Health Management Network Commercial |
$160.65
|
| Rate for Payer: MDX Hawaii PPO |
$183.33
|
|
|
HCHG PROTEIN-CSF
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
H3011110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$4.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.00
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.00
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HCHG PROTEIN-CSF
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
H3011110
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HCHG PROTEIN ELECTROPH CSF
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
K3010044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$17.83
|
| Rate for Payer: AlohaCare Medicare |
$17.83
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Devoted Health Medicare |
$19.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.83
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.83
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.83
|
| Rate for Payer: University Health Alliance Commercial |
$46.10
|
|
|
HCHG PROTEIN ELECTROPH CSF
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
K3010044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$142.35
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
