|
bismuth subsalicylate 262 mg Chew Tab [KMC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904720546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.26
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$2.76
|
| Rate for Payer: Devoted Health Medicare |
$1.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.26
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.26
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
bisoprolol 10 mg Tab [KMC]
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 70954045620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Health Management Network Commercial |
$7.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.11
|
| Rate for Payer: MDX Hawaii PPO |
$8.74
|
|
|
bisoprolol 10 mg Tab [KMC]
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 70954045620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$3.78
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$8.29
|
| Rate for Payer: Devoted Health Medicare |
$3.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.56
|
| Rate for Payer: Health Management Network Commercial |
$7.66
|
| Rate for Payer: Humana Medicare |
$3.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.78
|
| Rate for Payer: MDX Hawaii PPO |
$8.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.78
|
| Rate for Payer: University Health Alliance Commercial |
$6.57
|
|
|
bisoprolol 5 mg Tab [KMC]
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
NDC 70954045510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Health Management Network Commercial |
$7.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.11
|
| Rate for Payer: MDX Hawaii PPO |
$8.74
|
|
|
bisoprolol 5 mg Tab [KMC]
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
NDC 70954045510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$3.78
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$8.29
|
| Rate for Payer: Devoted Health Medicare |
$3.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.56
|
| Rate for Payer: Health Management Network Commercial |
$7.66
|
| Rate for Payer: Humana Medicare |
$3.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.78
|
| Rate for Payer: MDX Hawaii PPO |
$8.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.78
|
| Rate for Payer: University Health Alliance Commercial |
$6.57
|
|
|
BLADDER IRRIGATION CHARGE
|
Facility
|
OP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
440517000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$417.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$540.00
|
| Rate for Payer: AlohaCare Medicare |
$453.60
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$993.60
|
| Rate for Payer: Devoted Health Medicare |
$453.60
|
| 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 |
$453.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,026.00
|
| Rate for Payer: Health Management Network Commercial |
$918.00
|
| Rate for Payer: Humana Medicare |
$453.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$453.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,047.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$453.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$453.60
|
| Rate for Payer: University Health Alliance Commercial |
$787.21
|
|
|
BLADDER IRRIGATION CHARGE
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
440517000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Health Management Network Commercial |
$918.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$972.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,047.60
|
|
|
BLADDER, POST-VOID RESIDUAL
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
4501798
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$448.14 |
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Health Management Network Commercial |
$392.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$415.80
|
| Rate for Payer: MDX Hawaii PPO |
$448.14
|
|
|
BLADDER, POST-VOID RESIDUAL
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
4501798
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$448.14 |
| Rate for Payer: AlohaCare Medicaid |
$231.00
|
| Rate for Payer: AlohaCare Medicare |
$194.04
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$425.04
|
| Rate for Payer: Devoted Health Medicare |
$194.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$194.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$438.90
|
| Rate for Payer: Health Management Network Commercial |
$392.70
|
| Rate for Payer: Humana Medicare |
$194.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$415.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$235.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$194.04
|
| Rate for Payer: MDX Hawaii PPO |
$448.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$194.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$194.04
|
| Rate for Payer: University Health Alliance Commercial |
$336.75
|
|
|
Bleeding Time
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
422850020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$57.50
|
| Rate for Payer: AlohaCare Medicare |
$48.30
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$105.80
|
| Rate for Payer: Devoted Health Medicare |
$48.30
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$6.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$48.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.30
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.30
|
| Rate for Payer: University Health Alliance Commercial |
$11.64
|
|
|
Bleeding Time
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 85002
|
| Hospital Charge Code |
422850020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Cash Price |
$74.75
|
| 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
|
|
|
bleomycin 15 units/10 mL vial [KMC]
|
Facility
|
IP
|
$165.60
|
|
|
Service Code
|
HCPCS J9040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.76 |
| Max. Negotiated Rate |
$160.63 |
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Health Management Network Commercial |
$140.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.04
|
| Rate for Payer: MDX Hawaii PPO |
$160.63
|
|
|
bleomycin 15 units/10 mL vial [KMC]
|
Facility
|
OP
|
$165.60
|
|
|
Service Code
|
HCPCS J9040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$160.63 |
| Rate for Payer: AlohaCare Medicaid |
$82.80
|
| Rate for Payer: AlohaCare Medicare |
$69.55
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$152.35
|
| Rate for Payer: Devoted Health Medicare |
$69.55
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$20.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.32
|
| Rate for Payer: Health Management Network Commercial |
$140.76
|
| Rate for Payer: Humana Medicare |
$69.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.55
|
| Rate for Payer: MDX Hawaii PPO |
$160.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.55
|
| Rate for Payer: University Health Alliance Commercial |
$120.71
|
|
|
BLOOD COUNT HEMOGLOBIN
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 85018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: AlohaCare Medicaid |
$3.27
|
| Rate for Payer: AlohaCare Medicare |
$2.37
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Devoted Health Medicare |
$2.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.37
|
|
|
Blood Culture DLS
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
422870405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: AlohaCare Medicaid |
$78.50
|
| Rate for Payer: AlohaCare Medicare |
$65.94
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$144.44
|
| Rate for Payer: Devoted Health Medicare |
$65.94
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Humana Medicare |
$65.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.94
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.94
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
Blood Culture DLS
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 87040
|
| Hospital Charge Code |
422870405
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$133.45 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
|
|
Blood Gas Arterial
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
422828030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: AlohaCare Medicaid |
$253.00
|
| Rate for Payer: AlohaCare Medicare |
$212.52
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$465.52
|
| Rate for Payer: Devoted Health Medicare |
$212.52
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$212.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Humana Medicare |
$212.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$212.52
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$212.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$212.52
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
Blood Gas Arterial
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
422828030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$490.82 |
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Health Management Network Commercial |
$430.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.40
|
| Rate for Payer: MDX Hawaii PPO |
$490.82
|
|
|
Blood Gas Venous
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
422828030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$42.42
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$92.92
|
| Rate for Payer: Devoted Health Medicare |
$42.42
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$42.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.42
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.42
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
Blood Gas Venous
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
422828030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
Blood Glucose, Capillary POC
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
317829620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$15.54
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$34.04
|
| Rate for Payer: Devoted Health Medicare |
$15.54
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$15.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.54
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.54
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
Blood Glucose, Capillary POC
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
317829620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 82272
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: AlohaCare Medicaid |
$4.54
|
| Rate for Payer: AlohaCare Medicare |
$4.23
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Devoted Health Medicare |
$4.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.53
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.23
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 82270
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: AlohaCare Medicaid |
$4.49
|
| Rate for Payer: AlohaCare Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$4.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.50
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.38
|
|
|
BLOOD PRESSURE MEASURED
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 2000F
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$290.48 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$290.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$273.13
|
| Rate for Payer: Health Management Network Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$273.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$290.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$273.13
|
|
