|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELECTROPHORESIS SERUM
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3018416501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELP REFLEX IFE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3018416502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: AlohaCare Medicaid |
$10.74
|
| Rate for Payer: AlohaCare Medicare |
$10.74
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Devoted Health Medicare |
$11.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$10.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.74
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.74
|
| Rate for Payer: University Health Alliance Commercial |
$27.77
|
|
|
HC PROTEIN E-PHORESIS, SERUM - PROTEIN ELP REFLEX IFE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 84165
|
| Hospital Charge Code |
3018416502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPH CSF
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3018416602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.83
|
| Rate for Payer: AlohaCare Medicare |
$17.83
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| 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 |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.83
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| 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
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPH CSF
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3018416602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3018416601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$17.83
|
| Rate for Payer: AlohaCare Medicare |
$17.83
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| 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 |
$127.50
|
| Rate for Payer: Humana Medicare |
$17.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.83
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| 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
|
|
|
HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 84166
|
| Hospital Charge Code |
3018416601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3018415702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| 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 |
$28.90
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.00
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| 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
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3018415702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN TOT OTHER SOURCE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3018415701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| 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 |
$28.90
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.00
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| 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
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN TOT OTHER SOURCE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
3018415701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3018415501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$3.67
|
| Rate for Payer: AlohaCare Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$4.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.67
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.67
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY SERUM - PROTEIN TOTAL
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
3018415501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN RANDOM URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3018415601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$3.67
|
| Rate for Payer: AlohaCare Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$4.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.67
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.67
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN RANDOM URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3018415601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN TOTAL URINE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3018415602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$3.67
|
| Rate for Payer: AlohaCare Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$4.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.67
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.67
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HC PROTEIN TOT XCPT REFRACTOMETRY URINE - PROTEIN TOTAL URINE
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3018415602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3018415601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
|
|
HC PROTEIN URINE RANDOM
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
3018415601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: AlohaCare Medicaid |
$3.67
|
| Rate for Payer: AlohaCare Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$4.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$26.35
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.67
|
| Rate for Payer: MDX Hawaii PPO |
$30.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.67
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
3058561001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
3058561001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: AlohaCare Medicaid |
$4.29
|
| Rate for Payer: AlohaCare Medicare |
$4.29
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Devoted Health Medicare |
$4.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.29
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Humana Medicare |
$4.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.29
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.29
|
| Rate for Payer: University Health Alliance Commercial |
$10.16
|
|
|
HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
3058561101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
HC PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 85611
|
| Hospital Charge Code |
3058561101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$3.94
|
| Rate for Payer: AlohaCare Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$4.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$3.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.94
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.94
|
| Rate for Payer: University Health Alliance Commercial |
$10.19
|
|
|
HC PROTOZOA, NOT ELSEWHERE - AMOEBA AB SO
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
3028675301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
|
HC PROTOZOA, NOT ELSEWHERE - AMOEBA AB SO
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 86753
|
| Hospital Charge Code |
3028675301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: AlohaCare Medicaid |
$12.39
|
| Rate for Payer: AlohaCare Medicare |
$12.39
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$13.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.39
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$12.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.39
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.39
|
| Rate for Payer: University Health Alliance Commercial |
$32.04
|
|
