|
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
|
|
|
HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE - CULTURE AEROBIC ID ORG #3
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707703
|
|
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 #3
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
3068707703
|
|
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 BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
3018004801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
HC BASIC METABOLIC PANEL CALCIUM TOTAL - BUNDLED CHARGE
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
3018004801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$22.01
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Devoted Health Medicare |
$24.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.46
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$22.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.01
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.01
|
| Rate for Payer: University Health Alliance Commercial |
$21.89
|
|
|
HC BILIRUBIN TOTAL - BILIRUBIN TOTAL
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3018224703
|
|
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 BILIRUBIN TOTAL - BILIRUBIN TOTAL
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
3018224703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.02 |
| 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 |
$6.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.02
|
| 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 |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.02
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
HC BLOOD FOLIC ACID SERUM - FOLATE
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
3018274601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$119.31 |
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.70
|
| Rate for Payer: MDX Hawaii PPO |
$119.31
|
|
|
HC BLOOD FOLIC ACID SERUM - FOLATE
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
3018274601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$119.31 |
| Rate for Payer: AlohaCare Medicaid |
$61.50
|
| Rate for Payer: AlohaCare Medicare |
$38.13
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Devoted Health Medicare |
$41.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.70
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Humana Medicare |
$38.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$110.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.13
|
| Rate for Payer: MDX Hawaii PPO |
$119.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.13
|
| Rate for Payer: University Health Alliance Commercial |
$38.00
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$109.50
|
| Rate for Payer: AlohaCare Medicare |
$67.89
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$74.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$67.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.89
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.89
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT ARTERIAL BLOOD GAS
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - POCT ARTERIAL BLOOD GAS
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$109.50
|
| Rate for Payer: AlohaCare Medicare |
$67.89
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$74.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$67.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.89
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.89
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HC BLOOD GAS W/O2 SAT DIRECT
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
3018280501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: AlohaCare Medicaid |
$330.50
|
| Rate for Payer: AlohaCare Medicare |
$204.91
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Devoted Health Medicare |
$224.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$204.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Humana Medicare |
$204.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$594.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$337.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$204.91
|
| Rate for Payer: MDX Hawaii PPO |
$641.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$204.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$204.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$204.91
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
HC BLOOD GAS W/O2 SAT DIRECT
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
3018280501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$561.85 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Health Management Network Commercial |
$561.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$594.90
|
| Rate for Payer: MDX Hawaii PPO |
$641.17
|
|
|
HC BLOOD OCCULT GASTRIC
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: AlohaCare Medicaid |
$22.50
|
| Rate for Payer: AlohaCare Medicare |
$13.95
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$15.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.32
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Humana Medicare |
$13.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.95
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.95
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HC BLOOD OCCULT GASTRIC
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 82271
|
| Hospital Charge Code |
3018227101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.50
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
|
|
HC BLOOD OCCULT SINGLE QL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 82272 QW
|
| Hospital Charge Code |
3018227201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: AlohaCare Medicaid |
$17.50
|
| Rate for Payer: AlohaCare Medicare |
$10.85
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Devoted Health Medicare |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$33.25
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Humana Medicare |
$10.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.85
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.85
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HC BLOOD OCCULT SINGLE QL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 82272 QW
|
| Hospital Charge Code |
3018227201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: AlohaCare Medicaid |
$16.00
|
| Rate for Payer: AlohaCare Medicare |
$9.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$10.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.92
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$9.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.92
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.92
|
| Rate for Payer: University Health Alliance Commercial |
$8.90
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - BLD TYPING ABO
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,085.45 |
| Max. Negotiated Rate |
$1,238.69 |
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Health Management Network Commercial |
$1,085.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,149.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,238.69
|
|
|
HC BLOOD TYPING SEROLOGIC ABO - BLD TYPING ABO
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
3008690002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$1,238.69 |
| Rate for Payer: AlohaCare Medicaid |
$638.50
|
| Rate for Payer: AlohaCare Medicare |
$395.87
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Cash Price |
$766.20
|
| Rate for Payer: Devoted Health Medicare |
$434.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.12
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$395.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$1,085.45
|
| Rate for Payer: Humana Medicare |
$395.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,149.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$651.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$395.87
|
| Rate for Payer: MDX Hawaii PPO |
$1,238.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$395.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$395.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$395.87
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HC BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: AlohaCare Medicaid |
$194.50
|
| Rate for Payer: AlohaCare Medicare |
$120.59
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Devoted Health Medicare |
$132.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$120.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.99
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Humana Medicare |
$120.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.59
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.59
|
| Rate for Payer: University Health Alliance Commercial |
$7.71
|
|
|
HC BLOOD TYPING SEROLOGIC RH (D)
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
HCPCS 86901
|
| Hospital Charge Code |
3008690101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$330.65 |
| Max. Negotiated Rate |
$377.33 |
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Health Management Network Commercial |
$330.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$350.10
|
| Rate for Payer: MDX Hawaii PPO |
$377.33
|
|
