|
HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
3018383501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: AlohaCare Medicaid |
$16.94
|
| Rate for Payer: AlohaCare Medicare |
$16.94
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$18.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.94
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$16.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.94
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.94
|
| Rate for Payer: University Health Alliance Commercial |
$43.79
|
|
|
HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
3018383501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
|
HC ASSAY OF METANEPHRINES - METANEPHRINE UR QN SO
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
3018383502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.94 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: AlohaCare Medicaid |
$16.94
|
| Rate for Payer: AlohaCare Medicare |
$16.94
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Devoted Health Medicare |
$18.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.94
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: Humana Medicare |
$16.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.94
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.94
|
| Rate for Payer: University Health Alliance Commercial |
$43.79
|
|
|
HC ASSAY OF METANEPHRINES - METANEPHRINE UR QN SO
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS 83835
|
| Hospital Charge Code |
3018383502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.70 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Health Management Network Commercial |
$120.70
|
| Rate for Payer: MDX Hawaii PPO |
$137.74
|
|
|
HC ASSAY OF MYOGLOBIN - MYOGLOBIN URINE QUANTITATIVE
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3018387402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$12.92
|
| Rate for Payer: AlohaCare Medicare |
$12.92
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$14.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.92
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$12.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.92
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.92
|
| Rate for Payer: University Health Alliance Commercial |
$33.37
|
|
|
HC ASSAY OF MYOGLOBIN - MYOGLOBIN URINE QUANTITATIVE
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
3018387402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC ASSAY OF PARATHORMONE - PTH INTACT
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
3018397001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$335.62 |
| Rate for Payer: AlohaCare Medicaid |
$41.28
|
| Rate for Payer: AlohaCare Medicare |
$41.28
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Devoted Health Medicare |
$45.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$57.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.28
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
| Rate for Payer: Humana Medicare |
$41.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.28
|
| Rate for Payer: MDX Hawaii PPO |
$335.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.28
|
| Rate for Payer: University Health Alliance Commercial |
$106.69
|
|
|
HC ASSAY OF PARATHORMONE - PTH INTACT
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
HCPCS 83970
|
| Hospital Charge Code |
3018397001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$294.10 |
| Max. Negotiated Rate |
$335.62 |
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Health Management Network Commercial |
$294.10
|
| Rate for Payer: MDX Hawaii PPO |
$335.62
|
|
|
HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
3018018401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
HC ASSAY OF PHENOBARBITAL - PHENOBARBITAL
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 80184
|
| Hospital Charge Code |
3018018401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: AlohaCare Medicaid |
$15.30
|
| Rate for Payer: AlohaCare Medicare |
$15.30
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Devoted Health Medicare |
$16.83
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.30
|
| Rate for Payer: University Health Alliance Commercial |
$29.62
|
|
|
HC ASSAY OF PHENYTOIN, FREE - PHENYTOIN FREE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
3018018601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$13.76
|
| Rate for Payer: AlohaCare Medicare |
$13.76
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Devoted Health Medicare |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.76
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$13.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$72.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.76
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.76
|
| Rate for Payer: University Health Alliance Commercial |
$35.58
|
|
|
HC ASSAY OF PHENYTOIN, FREE - PHENYTOIN FREE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 80186
|
| Hospital Charge Code |
3018018601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
|
|
HC ASSAY OF PHENYTOIN, TOTAL - PHENYTOIN TOTAL
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
3018018502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$13.25
|
| Rate for Payer: AlohaCare Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.25
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.25
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
HC ASSAY OF PHENYTOIN, TOTAL - PHENYTOIN TOTAL
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
3018018502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
HC ASSAY OF PREALBUMIN - PREALBUMIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3018413401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HC ASSAY OF PREALBUMIN - PREALBUMIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3018413401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$14.59
|
| Rate for Payer: AlohaCare Medicare |
$14.59
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$16.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.59
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$14.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.59
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.59
|
| Rate for Payer: University Health Alliance Commercial |
$37.70
|
|
|
HC ASSAY OF PROLACTIN - PROLACTIN
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
3018414601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$19.38
|
| Rate for Payer: AlohaCare Medicare |
$19.38
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| 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 |
$138.55
|
| Rate for Payer: Humana Medicare |
$19.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.38
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| 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
|
|
|
HC ASSAY OF PROLACTIN - PROLACTIN
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
3018414601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
HC ASSAY OF RENIN - RENIN DIRECT ASSAY
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
3018424401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.99 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: AlohaCare Medicaid |
$21.99
|
| Rate for Payer: AlohaCare Medicare |
$21.99
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Devoted Health Medicare |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.99
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$21.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.99
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.99
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
|
|
HC ASSAY OF RENIN - RENIN DIRECT ASSAY
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
3018424401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
HC ASSAY OF SEROTONIN - SEROTONIN SERUM
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
3018426001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.98
|
| Rate for Payer: AlohaCare Medicare |
$30.98
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Devoted Health Medicare |
$34.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$38.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$44.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.98
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Humana Medicare |
$30.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.98
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.98
|
| Rate for Payer: University Health Alliance Commercial |
$80.07
|
|
|
HC ASSAY OF SEROTONIN - SEROTONIN SERUM
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
3018426001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
|
|
HC ASSAY OF SERUM ALBUMIN - ALBUMIN
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3018204001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HC ASSAY OF SERUM ALBUMIN - ALBUMIN
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3018204001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$4.95
|
| Rate for Payer: AlohaCare Medicare |
$4.95
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$5.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$4.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.95
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.95
|
| Rate for Payer: University Health Alliance Commercial |
$12.80
|
|
|
HC ASSAY OF SERUM POTASSIUM - POTASSIUM
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
3018413201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$4.76
|
| Rate for Payer: AlohaCare Medicare |
$4.76
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$5.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.76
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$4.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.76
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.76
|
| Rate for Payer: University Health Alliance Commercial |
$11.88
|
|
