|
HC DRAIN FINGER ABSCESS,SIMPLE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 26010
|
| Hospital Charge Code |
7612601001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC DRAIN SKIN ABSCESS COMPLIC
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
4501006101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$1,208.40
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$1,335.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,208.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$1,208.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,208.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,208.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,208.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,208.40
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRAIN SKIN ABSCESS COMPLIC
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
4501006101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4501006001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC DRAIN SKIN ABSCESS SIMPLE
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
4501006001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
HC DRESS/DEBRID LARGE BURN NO ANESTH
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
7611603001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC DRESS/DEBRID LARGE BURN NO ANESTH
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 16030
|
| Hospital Charge Code |
7611603001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$795.00
|
| Rate for Payer: AlohaCare Medicare |
$1,208.40
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$1,335.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,208.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,510.50
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$1,208.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,208.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,208.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,208.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,208.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
7611602501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$395.50
|
| Rate for Payer: AlohaCare Medicare |
$601.16
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Devoted Health Medicare |
$664.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$601.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$751.45
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Humana Medicare |
$601.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$601.16
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$601.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$601.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$601.16
|
| Rate for Payer: University Health Alliance Commercial |
$576.56
|
|
|
HC DRESS/DEBRID MED BURN NO ANESTH
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
HCPCS 16025
|
| Hospital Charge Code |
7611602501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.35 |
| Max. Negotiated Rate |
$767.27 |
| Rate for Payer: Cash Price |
$474.60
|
| Rate for Payer: Health Management Network Commercial |
$672.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$711.90
|
| Rate for Payer: MDX Hawaii PPO |
$767.27
|
|
|
HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION UR
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
3018034901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: AlohaCare Medicaid |
$480.00
|
| Rate for Payer: AlohaCare Medicare |
$729.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Devoted Health Medicare |
$806.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$912.00
|
| Rate for Payer: Health Management Network Commercial |
$816.00
|
| Rate for Payer: Humana Medicare |
$729.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.60
|
| Rate for Payer: MDX Hawaii PPO |
$931.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$729.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.60
|
| Rate for Payer: University Health Alliance Commercial |
$699.74
|
|
|
HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION UR
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
3018034901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Management Network Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.00
|
| Rate for Payer: MDX Hawaii PPO |
$931.20
|
|
|
HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
3018016401
|
|
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 DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
3018016401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| 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 |
$18.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.54
|
| 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 |
$18.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.64
|
| Rate for Payer: University Health Alliance Commercial |
$35.02
|
|
|
HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID FREE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 80165
|
| Hospital Charge Code |
3018016501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.16 |
| 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 Commercial |
$16.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.54
|
| 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 |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.64
|
| Rate for Payer: University Health Alliance Commercial |
$83.09
|
|
|
HC DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL - VALPROIC ACID FREE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 80165
|
| Hospital Charge Code |
3018016501
|
|
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 DRUG SCREEN QUANTITATIVE ALCOHOLS - ALCOHOLS QUANT SO
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
3018032001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: AlohaCare Medicaid |
$480.00
|
| Rate for Payer: AlohaCare Medicare |
$729.60
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Devoted Health Medicare |
$806.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$729.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$912.00
|
| Rate for Payer: Health Management Network Commercial |
$816.00
|
| Rate for Payer: Humana Medicare |
$729.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$729.60
|
| Rate for Payer: MDX Hawaii PPO |
$931.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$729.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$729.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$729.60
|
| Rate for Payer: University Health Alliance Commercial |
$699.74
|
|
|
HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ALCOHOLS QUANT SO
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
3018032001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Health Management Network Commercial |
$816.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$864.00
|
| Rate for Payer: MDX Hawaii PPO |
$931.20
|
|
|
HC DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
3018016201
|
|
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 DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL - DIGOXIN
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
3018016201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| 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 |
$18.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.28
|
| 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 |
$18.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.36
|
| Rate for Payer: University Health Alliance Commercial |
$34.32
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - ACETAMINOPHEN/TYLENOL
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: AlohaCare Medicaid |
$260.50
|
| Rate for Payer: AlohaCare Medicare |
$395.96
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Devoted Health Medicare |
$437.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Humana Medicare |
$395.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$265.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$395.96
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.96
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - ACETAMINOPHEN/TYLENOL
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$442.85 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: AlohaCare Medicaid |
$260.50
|
| Rate for Payer: AlohaCare Medicare |
$395.96
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Devoted Health Medicare |
$437.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Humana Medicare |
$395.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$265.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$395.96
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.96
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - ALCOHOL BLOOD
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$442.85 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCRN PAIN MANAGE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$442.85 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
|
|
HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCRN PAIN MANAGE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
3018030701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$505.37 |
| Rate for Payer: AlohaCare Medicaid |
$260.50
|
| Rate for Payer: AlohaCare Medicare |
$395.96
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Devoted Health Medicare |
$437.64
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Humana Medicare |
$395.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$265.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$395.96
|
| Rate for Payer: MDX Hawaii PPO |
$505.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.96
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
