|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT ARTERIAL BLOOD GAS
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT ARTERIAL BLOOD GAS
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$26.07
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| 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 |
$26.07
|
| 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 |
$186.15
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.07
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT VENOUS BLOOD GAS
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$26.07
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| 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 |
$26.07
|
| 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 |
$186.15
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.07
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT VENOUS BLOOD GAS
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HC BLOOD GAS VENOUS W/O2 SAT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
3018280502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$561.85 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: MDX Hawaii PPO |
$641.17
|
|
|
HC BLOOD GAS VENOUS W/O2 SAT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
3018280502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: AlohaCare Medicaid |
$78.77
|
| Rate for Payer: AlohaCare Medicare |
$78.77
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Devoted Health Medicare |
$86.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.77
|
| Rate for Payer: MDX Hawaii PPO |
$641.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.77
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
HC BLOOD GAS W/O2 SAT DIRECT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
3018280501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$561.85 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: MDX Hawaii PPO |
$641.17
|
|
|
HC BLOOD GAS W/O2 SAT DIRECT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
3018280501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: AlohaCare Medicaid |
$78.77
|
| Rate for Payer: AlohaCare Medicare |
$78.77
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Devoted Health Medicare |
$86.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Humana Medicare |
$78.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.77
|
| Rate for Payer: MDX Hawaii PPO |
$641.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.77
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.77
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
3018227002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$4.38
|
| Rate for Payer: AlohaCare Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$4.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$4.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.38
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.38
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
3018227002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$15.92
|
| Rate for Payer: AlohaCare Medicare |
$15.92
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$17.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.92
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$15.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.92
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.92
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
HC BLOOD OCCULT GASTRIC
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: AlohaCare Medicaid |
$5.32
|
| Rate for Payer: AlohaCare Medicare |
$5.32
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$5.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.32
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.32
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.32
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HC BLOOD OCCULT GASTRIC
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: AlohaCare Medicaid |
$11.00
|
| Rate for Payer: AlohaCare Medicare |
$11.00
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Devoted Health Medicare |
$12.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.00
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$11.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.00
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.00
|
| Rate for Payer: University Health Alliance Commercial |
$21.89
|
|
|
HC BLOOD PH - PH VENOUS
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 82800
|
| Hospital Charge Code |
3018280001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: AlohaCare Medicaid |
$3.80
|
| Rate for Payer: AlohaCare Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$4.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.80
|
| Rate for Payer: University Health Alliance Commercial |
$8.90
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$2,536.00 |
| Rate for Payer: AlohaCare Medicaid |
$521.18
|
| Rate for Payer: AlohaCare Medicare |
$521.18
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Devoted Health Medicare |
$573.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$521.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,314.20
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: Humana Medicare |
$521.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,534.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,242.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$521.18
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$573.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$521.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$521.18
|
| Rate for Payer: University Health Alliance Commercial |
$1,775.60
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$2,436.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$2,362.92 |
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Health Management Network Commercial |
$2,070.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,362.92
|
|
|
HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,029.40 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
|
|
HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: AlohaCare Medicaid |
$6.35
|
| Rate for Payer: AlohaCare Medicare |
$6.35
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Devoted Health Medicare |
$6.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.35
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Humana Medicare |
$6.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,245.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,817.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.35
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.35
|
| Rate for Payer: University Health Alliance Commercial |
$9.95
|
|
|
HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH - BLOOD TYPING, RBC
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
3008690501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,029.40 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
|
|
HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH - BLOOD TYPING, RBC
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
3008690501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$3,457.08 |
| Rate for Payer: AlohaCare Medicaid |
$3.83
|
| Rate for Payer: AlohaCare Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Cash Price |
$2,138.40
|
| Rate for Payer: Devoted Health Medicare |
$4.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.83
|
| Rate for Payer: Health Management Network Commercial |
$3,029.40
|
| Rate for Payer: Humana Medicare |
$3.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,245.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,817.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.83
|
| Rate for Payer: MDX Hawaii PPO |
$3,457.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.83
|
| Rate for Payer: University Health Alliance Commercial |
$9.88
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - BLD TYPING ABO
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,085.45 |
| Max. Negotiated Rate |
$1,238.69 |
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Health Management Network Commercial |
$1,085.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,238.69
|
|
