|
HC ASSAY OF GENTAMICIN - GENTAMICIN TROUGH
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
3018017001
|
|
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 INORGANIC PHOSPHORUS - PHOSPHORUS BLOOD
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
3018410001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
HC ASSAY OF INORGANIC PHOSPHORUS - PHOSPHORUS BLOOD
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 84100
|
| Hospital Charge Code |
3018410001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$33.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.74
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$30.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.40
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.40
|
| Rate for Payer: University Health Alliance Commercial |
$12.27
|
|
|
HC ASSAY OF IRON - IRON BLOOD
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
3018354001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.47 |
| 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 |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| 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 |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.04
|
| Rate for Payer: University Health Alliance Commercial |
$16.74
|
|
|
HC ASSAY OF IRON - IRON BLOOD
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
3018354001
|
|
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 LACTIC ACID - LACTATE
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
3018360502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$48.50
|
| Rate for Payer: AlohaCare Medicare |
$73.72
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Devoted Health Medicare |
$81.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$73.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.72
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.72
|
| Rate for Payer: University Health Alliance Commercial |
$27.60
|
|
|
HC ASSAY OF LACTIC ACID - LACTATE
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
3018360502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
HC ASSAY OF LIPASE - LIPASE
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
3018369001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$56.26 |
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.20
|
| Rate for Payer: MDX Hawaii PPO |
$56.26
|
|
|
HC ASSAY OF LIPASE - LIPASE
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
3018369001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$56.26 |
| Rate for Payer: AlohaCare Medicaid |
$29.00
|
| Rate for Payer: AlohaCare Medicare |
$44.08
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$48.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Humana Medicare |
$44.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.08
|
| Rate for Payer: MDX Hawaii PPO |
$56.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.08
|
| Rate for Payer: University Health Alliance Commercial |
$17.80
|
|
|
HC ASSAY OF LITHIUM - LITHIUM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
3018017801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.61 |
| 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 |
$9.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.61
|
| 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 |
$9.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.80
|
| Rate for Payer: University Health Alliance Commercial |
$17.09
|
|
|
HC ASSAY OF LITHIUM - LITHIUM
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
3018017801
|
|
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 MAGNESIUM - MAGNESIUM
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$42.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$47.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.70
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$42.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.56
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.56
|
| Rate for Payer: University Health Alliance Commercial |
$17.32
|
|
|
HC ASSAY OF MAGNESIUM - MAGNESIUM
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 83735
|
| Hospital Charge Code |
3018373501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
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 |
$173.00
|
| Rate for Payer: AlohaCare Medicare |
$262.96
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Cash Price |
$207.60
|
| Rate for Payer: Devoted Health Medicare |
$290.64
|
| 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 |
$262.96
|
| 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 |
$262.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$311.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$262.96
|
| Rate for Payer: MDX Hawaii PPO |
$335.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$262.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$262.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$262.96
|
| 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: Kaiser Permanente Commercial |
$311.40
|
| 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: Kaiser Permanente Commercial |
$115.20
|
| 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 |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$97.28
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Devoted Health Medicare |
$107.52
|
| 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 |
$97.28
|
| 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 |
$97.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.28
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.28
|
| Rate for Payer: University Health Alliance Commercial |
$29.62
|
|
|
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 |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$84.36
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Devoted Health Medicare |
$93.24
|
| 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 |
$84.36
|
| 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 |
$84.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.36
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.36
|
| 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: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
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 |
$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 |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.72
|
| 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 |
$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 |
$20.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.72
|
| Rate for Payer: University Health Alliance Commercial |
$37.70
|
|
|
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: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
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: Kaiser Permanente Commercial |
$37.80
|
| 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 |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$31.92
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$35.28
|
| 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 |
$31.92
|
| 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 |
$31.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.92
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.92
|
| Rate for Payer: University Health Alliance Commercial |
$12.80
|
|
|
HC ASSAY OF SERUM POTASSIUM - POTASSIUM
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
3018413201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
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 |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$30.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Devoted Health Medicare |
$33.60
|
| 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 |
$30.40
|
| 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 |
$30.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.40
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.40
|
| Rate for Payer: University Health Alliance Commercial |
$11.88
|
|
