|
HCHG VENT MGMT SUBSEQUENT DAY
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
H4100283
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,175.55 |
| Max. Negotiated Rate |
$1,341.51 |
| Rate for Payer: Cash Price |
$898.95
|
| Rate for Payer: Health Management Network Commercial |
$1,175.55
|
| Rate for Payer: MDX Hawaii PPO |
$1,341.51
|
|
|
HCHG VENT MGMT SUBSEQUENT DAY
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
H4100283
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$1,341.51 |
| Rate for Payer: AlohaCare Medicaid |
$729.82
|
| Rate for Payer: AlohaCare Medicare |
$729.82
|
| Rate for Payer: Cash Price |
$898.95
|
| Rate for Payer: Cash Price |
$898.95
|
| Rate for Payer: Devoted Health Medicare |
$802.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$912.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,313.85
|
| Rate for Payer: Health Management Network Commercial |
$1,175.55
|
| Rate for Payer: Humana Medicare |
$729.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$705.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.82
|
| Rate for Payer: MDX Hawaii PPO |
$1,341.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$802.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.82
|
| Rate for Payer: University Health Alliance Commercial |
$1,008.07
|
|
|
HCHG VEST PROCEDURE INITIAL
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4100270
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
|
|
HCHG VEST PROCEDURE INITIAL
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
H4100270
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$333.68 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Cash Price |
$223.60
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$326.80
|
| Rate for Payer: Health Management Network Commercial |
$292.40
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$216.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$175.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$333.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$250.74
|
|
|
HCHG VEST SUBSEQUENT
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
H4100271
|
|
Hospital Revenue Code
|
410
|
| 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 VEST SUBSEQUENT
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
H4100271
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$237.50
|
| Rate for Payer: Health Management Network Commercial |
$212.50
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$127.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$242.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$182.22
|
|
|
HCHG VIBRIO STOOL CULT
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
H3060520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: AlohaCare Medicaid |
$9.44
|
| Rate for Payer: AlohaCare Medicare |
$9.44
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$9.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.44
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.44
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
HCHG VIBRIO STOOL CULT
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
H3060520
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
HCHG VIRAL AB NOS SO
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
K3020019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$204.67 |
| Rate for Payer: Cash Price |
$137.15
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: MDX Hawaii PPO |
$204.67
|
|
|
HCHG VIRAL AB NOS SO
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
K3020019
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$204.67 |
| Rate for Payer: AlohaCare Medicaid |
$12.88
|
| Rate for Payer: AlohaCare Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$137.15
|
| Rate for Payer: Cash Price |
$137.15
|
| Rate for Payer: Devoted Health Medicare |
$14.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.88
|
| Rate for Payer: Health Management Network Commercial |
$179.35
|
| Rate for Payer: Humana Medicare |
$12.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.88
|
| Rate for Payer: MDX Hawaii PPO |
$204.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.88
|
| Rate for Payer: University Health Alliance Commercial |
$33.30
|
|
|
HCHG VIRAL ID TISS CULTURE ADD SO
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
K3060024
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$20.20
|
| Rate for Payer: AlohaCare Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$22.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$20.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.20
|
| Rate for Payer: University Health Alliance Commercial |
$23.18
|
|
|
HCHG VIRAL ID TISS CULTURE ADD SO
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
K3060024
|
|
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 VIRUS ISOLAT W ID NONIMMUNOLOG
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
H3060542
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$207.58 |
| Rate for Payer: AlohaCare Medicaid |
$33.86
|
| Rate for Payer: AlohaCare Medicare |
$33.86
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Devoted Health Medicare |
$37.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.86
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$45.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.86
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: Humana Medicare |
$33.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.86
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.86
|
| Rate for Payer: University Health Alliance Commercial |
$79.40
|
|
|
HCHG VIRUS ISOLAT W ID NONIMMUNOLOG
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 87255
|
| Hospital Charge Code |
H3060542
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$207.58 |
| Rate for Payer: Cash Price |
$139.10
|
| Rate for Payer: Health Management Network Commercial |
$181.90
|
| Rate for Payer: MDX Hawaii PPO |
$207.58
|
|
|
HCHG VITAL CAPACITY & NIF
|
Facility
|
OP
|
$937.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
H4600150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$908.89 |
| Rate for Payer: AlohaCare Medicaid |
$152.01
|
| Rate for Payer: AlohaCare Medicare |
$152.01
|
| Rate for Payer: Cash Price |
$609.05
|
| Rate for Payer: Cash Price |
$609.05
|
| Rate for Payer: Devoted Health Medicare |
$167.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$190.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$890.15
|
| Rate for Payer: Health Management Network Commercial |
$796.45
|
| Rate for Payer: Humana Medicare |
$152.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$477.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.01
|
| Rate for Payer: MDX Hawaii PPO |
$908.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$167.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.01
|
| Rate for Payer: University Health Alliance Commercial |
$682.98
|
|
|
HCHG VITAL CAPACITY & NIF
|
Facility
|
IP
|
$937.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
H4600150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$796.45 |
| Max. Negotiated Rate |
$908.89 |
| Rate for Payer: Cash Price |
$609.05
|
| Rate for Payer: Health Management Network Commercial |
$796.45
|
| Rate for Payer: MDX Hawaii PPO |
$908.89
|
|
|
HCHG VITAMIN A 90
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
H3011278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: AlohaCare Medicaid |
$11.61
|
| Rate for Payer: AlohaCare Medicare |
$11.61
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Devoted Health Medicare |
$12.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.61
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: Humana Medicare |
$11.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.61
|
| Rate for Payer: MDX Hawaii PPO |
$146.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.61
|
| Rate for Payer: University Health Alliance Commercial |
$29.97
|
|
|
HCHG VITAMIN A 90
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 84590
|
| Hospital Charge Code |
H3011278
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Health Management Network Commercial |
$128.35
|
| Rate for Payer: MDX Hawaii PPO |
$146.47
|
|
|
HCHG VITAMIN B1
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
H3011280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$313.31 |
| Rate for Payer: AlohaCare Medicaid |
$21.23
|
| Rate for Payer: AlohaCare Medicare |
$21.23
|
| Rate for Payer: Cash Price |
$209.95
|
| Rate for Payer: Cash Price |
$209.95
|
| Rate for Payer: Devoted Health Medicare |
$23.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.23
|
| Rate for Payer: Health Management Network Commercial |
$274.55
|
| Rate for Payer: Humana Medicare |
$21.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$203.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.23
|
| Rate for Payer: MDX Hawaii PPO |
$313.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.23
|
| Rate for Payer: University Health Alliance Commercial |
$49.30
|
|
|
HCHG VITAMIN B1
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
H3011280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$274.55 |
| Max. Negotiated Rate |
$313.31 |
| Rate for Payer: Cash Price |
$209.95
|
| Rate for Payer: Health Management Network Commercial |
$274.55
|
| Rate for Payer: MDX Hawaii PPO |
$313.31
|
|
|
HCHG VITAMIN B-12
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
H3011282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: AlohaCare Medicaid |
$15.08
|
| Rate for Payer: AlohaCare Medicare |
$15.08
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Devoted Health Medicare |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.08
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.08
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.08
|
| Rate for Payer: University Health Alliance Commercial |
$38.96
|
|
|
HCHG VITAMIN B-12
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 82607
|
| Hospital Charge Code |
H3011282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
|
|
HCHG VITAMIN B12 BINDNG CAP SO
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 82608
|
| Hospital Charge Code |
K3010026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$170.72 |
| Rate for Payer: AlohaCare Medicaid |
$14.32
|
| Rate for Payer: AlohaCare Medicare |
$14.32
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Devoted Health Medicare |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.32
|
| Rate for Payer: Health Management Network Commercial |
$149.60
|
| Rate for Payer: Humana Medicare |
$14.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.32
|
| Rate for Payer: MDX Hawaii PPO |
$170.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.32
|
| Rate for Payer: University Health Alliance Commercial |
$37.02
|
|
|
HCHG VITAMIN B12 BINDNG CAP SO
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 82608
|
| Hospital Charge Code |
K3010026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$170.72 |
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Management Network Commercial |
$149.60
|
| Rate for Payer: MDX Hawaii PPO |
$170.72
|
|
|
HCHG VITAMIN B2
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 84252
|
| Hospital Charge Code |
H3011284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: AlohaCare Medicaid |
$20.24
|
| Rate for Payer: AlohaCare Medicare |
$20.24
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Devoted Health Medicare |
$22.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.24
|
| Rate for Payer: Health Management Network Commercial |
$161.50
|
| Rate for Payer: Humana Medicare |
$20.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.24
|
| Rate for Payer: MDX Hawaii PPO |
$184.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.24
|
| Rate for Payer: University Health Alliance Commercial |
$49.30
|
|
