|
STOMACH TUBE (LEVIN TYPE) 14FR
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
8295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
STOMACH TUBE (LEVIN TYPE) 14FR
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
8295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$2.52
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$5.52
|
| Rate for Payer: Devoted Health Medicare |
$2.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$2.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.52
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.52
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
Stool Culture w/ Shiga Toxin EIA DLS
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
422870455
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$86.10
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$188.60
|
| Rate for Payer: Devoted Health Medicare |
$86.10
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$13.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$86.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.10
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.10
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
Stool Culture w/ Shiga Toxin EIA DLS
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
422870455
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
STRAPPING, ANKLE AND/OR FOOT CHARGE
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
440295400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
|
|
STRAPPING, ANKLE AND/OR FOOT CHARGE
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
440295400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$143.00
|
| Rate for Payer: AlohaCare Medicare |
$120.12
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$263.12
|
| Rate for Payer: Devoted Health Medicare |
$120.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Humana Medicare |
$120.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.12
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.12
|
| Rate for Payer: University Health Alliance Commercial |
$208.47
|
|
|
STRAPPING HAND/FINGER
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 29280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: AlohaCare Medicaid |
$20.04
|
| Rate for Payer: AlohaCare Medicare |
$16.88
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Devoted Health Medicare |
$16.88
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$20.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.36
|
| Rate for Payer: Health Management Network Commercial |
$178.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.88
|
| Rate for Payer: University Health Alliance Commercial |
$26.04
|
|
|
STRAPPING, KNEE CHARGE
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
440295300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$143.00
|
| Rate for Payer: AlohaCare Medicare |
$120.12
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$263.12
|
| Rate for Payer: Devoted Health Medicare |
$120.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Humana Medicare |
$120.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.12
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.12
|
| Rate for Payer: University Health Alliance Commercial |
$208.47
|
|
|
STRAPPING, KNEE CHARGE
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
440295300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
|
|
STRAPPING; THORAX CHARGE
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
440292000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$143.00
|
| Rate for Payer: AlohaCare Medicare |
$120.12
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$263.12
|
| Rate for Payer: Devoted Health Medicare |
$120.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Humana Medicare |
$120.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.12
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.12
|
| Rate for Payer: University Health Alliance Commercial |
$208.47
|
|
|
STRAPPING; THORAX CHARGE
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
440292000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
|
|
STRAPPING UNNA BOOT
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 29580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$430.10 |
| Rate for Payer: AlohaCare Medicaid |
$25.73
|
| Rate for Payer: AlohaCare Medicare |
$22.81
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Devoted Health Medicare |
$22.81
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$25.73
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.58
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.81
|
| Rate for Payer: University Health Alliance Commercial |
$34.82
|
|
|
STRAPPING-UNNA BOOT Charge
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
440295800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$297.36
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$651.36
|
| Rate for Payer: Devoted Health Medicare |
$297.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$297.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$297.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$297.36
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$297.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$297.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$297.36
|
| Rate for Payer: University Health Alliance Commercial |
$516.06
|
|
|
STRAPPING-UNNA BOOT Charge
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 29580
|
| Hospital Charge Code |
440295800
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
STRAP SHOULDER (VALPEAU) Charge
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
440292400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$143.00
|
| Rate for Payer: AlohaCare Medicare |
$120.12
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$263.12
|
| Rate for Payer: Devoted Health Medicare |
$120.12
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$417.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Humana Medicare |
$120.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.12
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.12
|
| Rate for Payer: University Health Alliance Commercial |
$208.47
|
|
|
STRAP SHOULDER (VALPEAU) Charge
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
440292400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
|
|
Strep A (ID Now)
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
422878800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: AlohaCare Medicaid |
$31.00
|
| Rate for Payer: AlohaCare Medicare |
$26.04
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$57.04
|
| Rate for Payer: Devoted Health Medicare |
$26.04
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.53
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Humana Medicare |
$26.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.04
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.04
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Strep A (ID Now)
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
HCPCS 87880
|
| Hospital Charge Code |
422878800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.70 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.80
|
| Rate for Payer: MDX Hawaii PPO |
$60.14
|
|
|
Strep A Screen
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
422874300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$69.72
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$152.72
|
| Rate for Payer: Devoted Health Medicare |
$69.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.81
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$69.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.72
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.72
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Strep A Screen
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
422874300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
Strep A Screen 4
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
422874300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$69.72
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$152.72
|
| Rate for Payer: Devoted Health Medicare |
$69.72
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.81
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$69.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.72
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.72
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Strep A Screen 4
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 87430
|
| Hospital Charge Code |
422874300
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
streptomycin 1000 mg vial [KMC]
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS J3000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
|
|
streptomycin 1000 mg vial [KMC]
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS J3000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: AlohaCare Medicaid |
$187.50
|
| Rate for Payer: AlohaCare Medicare |
$157.50
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$345.00
|
| Rate for Payer: Devoted Health Medicare |
$157.50
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$31.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.25
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Humana Medicare |
$157.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$157.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$225.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.50
|
| Rate for Payer: University Health Alliance Commercial |
$273.34
|
|
|
Streptozyme DLS
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
422864035
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: AlohaCare Medicaid |
$62.00
|
| Rate for Payer: AlohaCare Medicare |
$52.08
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Cash Price |
$80.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$114.08
|
| Rate for Payer: Devoted Health Medicare |
$52.08
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$14.08
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Humana Medicare |
$52.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.08
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.08
|
| Rate for Payer: University Health Alliance Commercial |
$26.34
|
|
