|
HC ASSAY OF VITAMIN B-1 - THIAMINE/VITAMIN B1 SO
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$151.30 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.20
|
| Rate for Payer: MDX Hawaii PPO |
$172.66
|
|
|
HC ASSAY OF VITAMIN B-1 - THIAMINE/VITAMIN B1 SO
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 84425
|
| Hospital Charge Code |
3018442501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: AlohaCare Medicaid |
$89.00
|
| Rate for Payer: AlohaCare Medicare |
$55.18
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Devoted Health Medicare |
$60.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.36
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.23
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Humana Medicare |
$55.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.18
|
| Rate for Payer: MDX Hawaii PPO |
$172.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.18
|
| Rate for Payer: University Health Alliance Commercial |
$49.30
|
|
|
HC ASSAY OF VITAMIN K - VITAMIN K
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 84597
|
| Hospital Charge Code |
3018459701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$57.50
|
| Rate for Payer: AlohaCare Medicare |
$35.65
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Devoted Health Medicare |
$39.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.65
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$35.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.65
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.65
|
| Rate for Payer: University Health Alliance Commercial |
$35.43
|
|
|
HC ASSAY OF VITAMIN K - VITAMIN K
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 84597
|
| Hospital Charge Code |
3018459701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Cash Price |
$69.00
|
| 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
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 250H D2 D3 SO
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
3018230601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$240.56 |
| Rate for Payer: AlohaCare Medicaid |
$124.00
|
| Rate for Payer: AlohaCare Medicare |
$76.88
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Devoted Health Medicare |
$84.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.60
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Humana Medicare |
$76.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$223.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.88
|
| Rate for Payer: MDX Hawaii PPO |
$240.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.88
|
| Rate for Payer: University Health Alliance Commercial |
$76.52
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 250H D2 D3 SO
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
3018230601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$240.56 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$223.20
|
| Rate for Payer: MDX Hawaii PPO |
$240.56
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 25OH INC FRAC
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
3018230602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$240.56 |
| Rate for Payer: AlohaCare Medicaid |
$124.00
|
| Rate for Payer: AlohaCare Medicare |
$76.88
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Devoted Health Medicare |
$84.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$40.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$42.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.60
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Humana Medicare |
$76.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$223.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$126.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.88
|
| Rate for Payer: MDX Hawaii PPO |
$240.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.88
|
| Rate for Payer: University Health Alliance Commercial |
$76.52
|
|
|
HC ASSAY OF VIT D,CALCIFEDIOL W FRACTIONS, IF PERFORMED - VIT D 25OH INC FRAC
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
3018230602
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$240.56 |
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Health Management Network Commercial |
$210.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$223.20
|
| Rate for Payer: MDX Hawaii PPO |
$240.56
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE BLOOD QT
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3018294701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$11.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.93
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$10.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.23
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.23
|
| Rate for Payer: University Health Alliance Commercial |
$10.14
|
|
|
HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE BLOOD QT
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
3018294701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
3018444301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.85 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
|
|
HC ASSAY THYROID STIM HORMONE - THYROID STIMULATING HORMONE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
3018444301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$136.77 |
| Rate for Payer: AlohaCare Medicaid |
$70.50
|
| Rate for Payer: AlohaCare Medicare |
$43.71
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Devoted Health Medicare |
$47.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network Commercial |
$119.85
|
| Rate for Payer: Humana Medicare |
$43.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.71
|
| Rate for Payer: MDX Hawaii PPO |
$136.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.71
|
| Rate for Payer: University Health Alliance Commercial |
$43.42
|
|
|
HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
3018452001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
HC ASSAY UREA NITROGEN, QUAN - BLOOD UREA NITROGEN
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
3018452001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$11.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.95
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$10.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.23
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.23
|
| Rate for Payer: University Health Alliance Commercial |
$10.19
|
|
|
HC ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
HCPCS 82190
|
| Hospital Charge Code |
3018219001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$41.23
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Devoted Health Medicare |
$45.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.23
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.90
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$41.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.23
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.23
|
| Rate for Payer: University Health Alliance Commercial |
$38.54
|
|
|
HC ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
HCPCS 82190
|
| Hospital Charge Code |
3018219001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
HC AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, EACH ADDITIONAL NAIL PLATE
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
4501173201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$134.00
|
| Rate for Payer: AlohaCare Medicare |
$83.08
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Devoted Health Medicare |
$91.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$254.60
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Humana Medicare |
$83.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.08
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.08
|
| Rate for Payer: University Health Alliance Commercial |
$195.35
|
|
|
HC AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, EACH ADDITIONAL NAIL PLATE
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
4501173201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.80 |
| Max. Negotiated Rate |
$259.96 |
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Health Management Network Commercial |
$227.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$241.20
|
| Rate for Payer: MDX Hawaii PPO |
$259.96
|
|
|
HC BACTERIA CULTURE SCREEN - CULT GC SCREEN
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$17.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Devoted Health Medicare |
$19.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.63
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$17.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.36
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.36
|
| Rate for Payer: University Health Alliance Commercial |
$17.13
|
|
|
HC BACTERIA CULTURE SCREEN - CULT GC SCREEN
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
3068708104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULT AEROBIC ID EA
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULT AEROBIC ID EA
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$23.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$21.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.08
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID #4
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707704
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$23.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$21.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.08
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID #4
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707704
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
|
|
HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID ORG #2
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707702
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$65.96 |
| Rate for Payer: AlohaCare Medicaid |
$34.00
|
| Rate for Payer: AlohaCare Medicare |
$21.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Devoted Health Medicare |
$23.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
| Rate for Payer: Humana Medicare |
$21.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.08
|
| Rate for Payer: MDX Hawaii PPO |
$65.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.08
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
