|
Catheter Tip Culture DLS
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
422870715
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: AlohaCare Medicaid |
$89.00
|
| Rate for Payer: AlohaCare Medicare |
$74.76
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$163.76
|
| Rate for Payer: Devoted Health Medicare |
$74.76
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$7.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.89
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Humana Medicare |
$74.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.76
|
| Rate for Payer: MDX Hawaii PPO |
$172.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.76
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
CATH KIT FEMALE
|
Facility
|
OP
|
$113.00
|
|
| Hospital Charge Code |
8047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: AlohaCare Medicaid |
$56.50
|
| Rate for Payer: AlohaCare Medicare |
$47.46
|
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$103.96
|
| Rate for Payer: Devoted Health Medicare |
$47.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$107.35
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Humana Medicare |
$47.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.46
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.46
|
| Rate for Payer: University Health Alliance Commercial |
$82.37
|
|
|
CATH KIT FEMALE
|
Facility
|
IP
|
$113.00
|
|
| Hospital Charge Code |
8047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.05 |
| Max. Negotiated Rate |
$109.61 |
| Rate for Payer: Cash Price |
$73.45
|
| Rate for Payer: Health Management Network Commercial |
$96.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.70
|
| Rate for Payer: MDX Hawaii PPO |
$109.61
|
|
|
CATH KIT INFANT
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
8048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
CATH KIT INFANT
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
8048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$2.10
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$4.60
|
| Rate for Payer: Devoted Health Medicare |
$2.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$2.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.10
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.10
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
|
CATH STABILIZATION DEVICE
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
8049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
|
|
CATH STABILIZATION DEVICE
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
8049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$16.49 |
| Rate for Payer: AlohaCare Medicaid |
$8.50
|
| Rate for Payer: AlohaCare Medicare |
$7.14
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$15.64
|
| Rate for Payer: Devoted Health Medicare |
$7.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$14.45
|
| Rate for Payer: Humana Medicare |
$7.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.14
|
| Rate for Payer: MDX Hawaii PPO |
$16.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.14
|
| Rate for Payer: University Health Alliance Commercial |
$12.39
|
|
|
CBC w/ Auto Diff 3
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
422850250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$77.28
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$169.28
|
| Rate for Payer: Devoted Health Medicare |
$77.28
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$77.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.28
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.28
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
CBC w/ Auto Diff 3
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
422850250
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
CBC w/ Diff & Platelet Count DLS
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
422850255
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$77.28
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$169.28
|
| Rate for Payer: Devoted Health Medicare |
$77.28
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$77.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.28
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.28
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
CBC w/ Diff & Platelet Count DLS
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
422850255
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
C-Citrullinated Peptide, IgG DLS
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 84681
|
| Hospital Charge Code |
422846815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$51.24
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Cash Price |
$79.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$112.24
|
| Rate for Payer: Devoted Health Medicare |
$51.24
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$28.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$51.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.24
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.24
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
C-Citrullinated Peptide, IgG DLS
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 84681
|
| Hospital Charge Code |
422846815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$79.30
|
| 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
|
|
|
C-COLLAR MED
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
8050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$7.56
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$16.56
|
| Rate for Payer: Devoted Health Medicare |
$7.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$7.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.56
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.56
|
| Rate for Payer: University Health Alliance Commercial |
$10.08
|
|
|
C-COLLAR MED
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
8050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: University Health Alliance Commercial |
$10.08
|
|
|
C-COLLAR MED LIFEGAURD
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
8051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$7.56
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$16.56
|
| Rate for Payer: Devoted Health Medicare |
$7.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$7.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.56
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.56
|
| Rate for Payer: University Health Alliance Commercial |
$10.08
|
|
|
C-COLLAR MED LIFEGAURD
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
8051
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: University Health Alliance Commercial |
$10.08
|
|
|
C-COLLAR ONE PIECE REGULAR
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
8052
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.90
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: University Health Alliance Commercial |
$15.12
|
|
|
C-COLLAR ONE PIECE REGULAR
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
8052
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: AlohaCare Medicaid |
$13.50
|
| Rate for Payer: AlohaCare Medicare |
$11.34
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$24.84
|
| Rate for Payer: Devoted Health Medicare |
$11.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.90
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Humana Medicare |
$11.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.34
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.34
|
| Rate for Payer: University Health Alliance Commercial |
$15.12
|
|
|
C-COLLAR ONE PIECE TALL
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
8053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: University Health Alliance Commercial |
$11.20
|
|
|
C-COLLAR ONE PIECE TALL
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
8053
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$18.40
|
| Rate for Payer: Devoted Health Medicare |
$8.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.40
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.40
|
| Rate for Payer: University Health Alliance Commercial |
$11.20
|
|
|
C-COLLAR XXS
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
8055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$8.40
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$18.40
|
| Rate for Payer: Devoted Health Medicare |
$8.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$8.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.40
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.40
|
| Rate for Payer: University Health Alliance Commercial |
$11.20
|
|
|
C-COLLAR XXS
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
8055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: University Health Alliance Commercial |
$11.20
|
|
|
C Cystatin DLS
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 82610
|
| Hospital Charge Code |
422826105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
C Cystatin DLS
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 82610
|
| Hospital Charge Code |
422826105
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$28.14
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$61.64
|
| Rate for Payer: Devoted Health Medicare |
$28.14
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$19.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.52
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$28.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.14
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.14
|
| Rate for Payer: University Health Alliance Commercial |
$35.15
|
|
