|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$313.31 |
| Rate for Payer: AlohaCare Medicaid |
$161.50
|
| Rate for Payer: AlohaCare Medicare |
$245.48
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Devoted Health Medicare |
$271.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.19
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$55.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.50
|
| Rate for Payer: Health Management Network Commercial |
$274.55
|
| Rate for Payer: Humana Medicare |
$245.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$245.48
|
| Rate for Payer: MDX Hawaii PPO |
$313.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.48
|
| Rate for Payer: University Health Alliance Commercial |
$99.49
|
|
|
HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
HCPCS 82652
|
| Hospital Charge Code |
3018265201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$274.55 |
| Max. Negotiated Rate |
$313.31 |
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Health Management Network Commercial |
$274.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.70
|
| Rate for Payer: MDX Hawaii PPO |
$313.31
|
|
|
HC ASSAY, NON-ENDOCRINE RECEPTOR - SOLUBLE TRANSFERR RECP SO
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
3018423801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: AlohaCare Medicaid |
$153.50
|
| Rate for Payer: AlohaCare Medicare |
$233.32
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Devoted Health Medicare |
$257.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$233.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.57
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Humana Medicare |
$233.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.32
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$233.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$233.32
|
| Rate for Payer: University Health Alliance Commercial |
$94.52
|
|
|
HC ASSAY, NON-ENDOCRINE RECEPTOR - SOLUBLE TRANSFERR RECP SO
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS 84238
|
| Hospital Charge Code |
3018423801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Health Management Network Commercial |
$260.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.30
|
| Rate for Payer: MDX Hawaii PPO |
$297.79
|
|
|
HC ASSAY OF AMMONIA - AMMONIA
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
3018214001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$92.72
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$102.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$92.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.72
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.72
|
| Rate for Payer: University Health Alliance Commercial |
$37.67
|
|
|
HC ASSAY OF AMMONIA - AMMONIA
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82140
|
| Hospital Charge Code |
3018214001
|
|
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: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HC ASSAY OF AMYLASE - AMYLASE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
3018215005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.60
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
|
|
HC ASSAY OF AMYLASE - AMYLASE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
3018215005
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$52.38 |
| Rate for Payer: AlohaCare Medicaid |
$27.00
|
| Rate for Payer: AlohaCare Medicare |
$41.04
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Devoted Health Medicare |
$45.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.48
|
| Rate for Payer: Health Management Network Commercial |
$45.90
|
| Rate for Payer: Humana Medicare |
$41.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.04
|
| Rate for Payer: MDX Hawaii PPO |
$52.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.04
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
|
|
HC ASSAY OF CALCIUM, IONIZED - CALCIUM IONIZED SO
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
3018233001
|
|
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: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
|
|
HC ASSAY OF CALCIUM, IONIZED - CALCIUM IONIZED SO
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
3018233001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$57.50
|
| Rate for Payer: AlohaCare Medicare |
$87.40
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Devoted Health Medicare |
$96.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.68
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$87.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.40
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.40
|
| Rate for Payer: University Health Alliance Commercial |
$35.32
|
|
|
HC ASSAY OF CALCIUM, TOTAL - CALCIUM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
3018231001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC ASSAY OF CALCIUM, TOTAL - CALCIUM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 82310
|
| Hospital Charge Code |
3018231001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$32.68
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$36.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.16
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$32.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.68
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.68
|
| Rate for Payer: University Health Alliance Commercial |
$13.32
|
|
|
HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
3018015601
|
|
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: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
3018015601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$92.72
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$102.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.57
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$92.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.72
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.72
|
| Rate for Payer: University Health Alliance Commercial |
$37.63
|
|
|
HC ASSAY OF CK (CPK) - CK
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
3018255001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
|
|
HC ASSAY OF CK (CPK) - CK
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
3018255001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: AlohaCare Medicaid |
$27.50
|
| Rate for Payer: AlohaCare Medicare |
$41.80
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Devoted Health Medicare |
$46.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.51
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Humana Medicare |
$41.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.80
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.80
|
| Rate for Payer: University Health Alliance Commercial |
$16.84
|
|
|
HC ASSAY OF CREATININE - CREATININE BLOOD
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
3018256501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC ASSAY OF CREATININE - CREATININE BLOOD
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 82565
|
| Hospital Charge Code |
3018256501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$32.68
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$36.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.12
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$32.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.68
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.68
|
| Rate for Payer: University Health Alliance Commercial |
$13.25
|
|
|
HC ASSAY OF FERRITIN - FERRITIN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
3018272801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
HC ASSAY OF FERRITIN - FERRITIN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
3018272801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$86.64
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$95.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.63
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$86.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.64
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.64
|
| Rate for Payer: University Health Alliance Commercial |
$29.56
|
|
|
HC ASSAY OF FREE THYROXINE - T4 FREE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
3018443901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: AlohaCare Medicaid |
$38.00
|
| Rate for Payer: AlohaCare Medicare |
$57.76
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Devoted Health Medicare |
$63.84
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.02
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Humana Medicare |
$57.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.76
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.76
|
| Rate for Payer: University Health Alliance Commercial |
$23.31
|
|
|
HC ASSAY OF FREE THYROXINE - T4 FREE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 84439
|
| Hospital Charge Code |
3018443901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Management Network Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.40
|
| Rate for Payer: MDX Hawaii PPO |
$73.72
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.45 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN PEAK
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$104.12
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$115.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.38
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$104.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.12
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.12
|
| Rate for Payer: University Health Alliance Commercial |
$42.37
|
|
|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$132.89 |
| Rate for Payer: AlohaCare Medicaid |
$68.50
|
| Rate for Payer: AlohaCare Medicare |
$104.12
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Devoted Health Medicare |
$115.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$104.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.38
|
| Rate for Payer: Health Management Network Commercial |
$116.45
|
| Rate for Payer: Humana Medicare |
$104.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$123.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$104.12
|
| Rate for Payer: MDX Hawaii PPO |
$132.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$104.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$104.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$104.12
|
| Rate for Payer: University Health Alliance Commercial |
$42.37
|
|
