|
HC ASSAY OF PREALBUMIN - PREALBUMIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
3018413401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicare |
$37.82
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Devoted Health Medicare |
$41.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.59
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$37.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.82
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.82
|
| Rate for Payer: University Health Alliance Commercial |
$37.70
|
|
|
HC ASSAY OF PROGESTERONE - PROGESTERONE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
3018414401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
|
|
HC ASSAY OF PROGESTERONE - PROGESTERONE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
3018414401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$54.25
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Devoted Health Medicare |
$59.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.25
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.86
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$54.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.25
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.25
|
| Rate for Payer: University Health Alliance Commercial |
$53.93
|
|
|
HC ASSAY OF SERUM ALBUMIN - ALBUMIN
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3018204001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$13.02
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Devoted Health Medicare |
$14.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.95
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$13.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.02
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.02
|
| Rate for Payer: University Health Alliance Commercial |
$12.80
|
|
|
HC ASSAY OF SERUM ALBUMIN - ALBUMIN
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82040
|
| Hospital Charge Code |
3018204001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
3018440301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
|
|
HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
3018440301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: AlohaCare Medicaid |
$108.50
|
| Rate for Payer: AlohaCare Medicare |
$67.27
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Devoted Health Medicare |
$73.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.81
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Humana Medicare |
$67.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.27
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.27
|
| Rate for Payer: University Health Alliance Commercial |
$66.75
|
|
|
HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
3018443601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$56.26 |
| Rate for Payer: AlohaCare Medicaid |
$29.00
|
| Rate for Payer: AlohaCare Medicare |
$17.98
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Devoted Health Medicare |
$19.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.87
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Humana Medicare |
$17.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.98
|
| Rate for Payer: MDX Hawaii PPO |
$56.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.98
|
| Rate for Payer: University Health Alliance Commercial |
$17.78
|
|
|
HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE)
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
3018443601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$56.26 |
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Health Management Network Commercial |
$49.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.20
|
| Rate for Payer: MDX Hawaii PPO |
$56.26
|
|
|
HC ASSAY OF TROPONIN QUANTITATIVE - TROPONIN I HS (iSTAT)
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
3018448403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
HC ASSAY OF TROPONIN QUANTITATIVE - TROPONIN I HS (iSTAT)
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
3018448403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: AlohaCare Medicaid |
$52.50
|
| Rate for Payer: AlohaCare Medicare |
$32.55
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$35.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$32.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.55
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.55
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HC ASSAY OF TROPONIN, QUANT - TROPONIN T GEN 5
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
3018448401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
|
|
HC ASSAY OF TROPONIN, QUANT - TROPONIN T GEN 5
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
3018448401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$101.85 |
| Rate for Payer: AlohaCare Medicaid |
$52.50
|
| Rate for Payer: AlohaCare Medicare |
$32.55
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$35.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$89.25
|
| Rate for Payer: Humana Medicare |
$32.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.55
|
| Rate for Payer: MDX Hawaii PPO |
$101.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.55
|
| Rate for Payer: University Health Alliance Commercial |
$25.44
|
|
|
HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE - URIC ACID BODY FLUID
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
3018456002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$13.33
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$14.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.08
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$13.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.33
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.33
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE - URIC ACID BODY FLUID
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
3018456002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC ASSAY OF URIC ACID, BLOOD - URIC ACID
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
3018455001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: AlohaCare Medicaid |
$19.00
|
| Rate for Payer: AlohaCare Medicare |
$11.78
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Devoted Health Medicare |
$12.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.52
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Humana Medicare |
$11.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.78
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.78
|
| Rate for Payer: University Health Alliance Commercial |
$11.67
|
|
|
HC ASSAY OF URIC ACID, BLOOD - URIC ACID
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
3018455001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$36.86 |
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Health Management Network Commercial |
$32.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.20
|
| Rate for Payer: MDX Hawaii PPO |
$36.86
|
|
|
HC ASSAY OF URINE CREATININE - CREATININE RANDOM URINE
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3018257002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$13.33
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Devoted Health Medicare |
$14.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$13.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.33
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.33
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
HC ASSAY OF URINE CREATININE - CREATININE RANDOM URINE
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
3018257002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN RANDOM
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020202
|
|
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 ASSAY OF VANCOMYCIN - VANCOMYCIN RANDOM
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020202
|
|
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 |
$35.34
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$38.76
|
| 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 |
$35.34
|
| 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 |
$35.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.34
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.34
|
| Rate for Payer: University Health Alliance Commercial |
$35.02
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020201
|
|
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 |
$35.34
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Devoted Health Medicare |
$38.76
|
| 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 |
$35.34
|
| 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 |
$35.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.34
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.34
|
| Rate for Payer: University Health Alliance Commercial |
$35.02
|
|
|
HC ASSAY OF VANCOMYCIN - VANCOMYCIN TROUGH
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
3018020201
|
|
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 ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: AlohaCare Medicaid |
$142.50
|
| Rate for Payer: AlohaCare Medicare |
$88.35
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Devoted Health Medicare |
$96.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$42.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.94
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Humana Medicare |
$88.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.35
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.35
|
| Rate for Payer: University Health Alliance Commercial |
$87.75
|
|
|
HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
3018458801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Health Management Network Commercial |
$242.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$256.50
|
| Rate for Payer: MDX Hawaii PPO |
$276.45
|
|
