|
ANTEGRADE FEMORAL NAIL, RT, 9MM X 44CM
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12971680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,305.00
|
| Rate for Payer: AlohaCare Medicare |
$2,305.00
|
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Devoted Health Medicare |
$2,535.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Humana Medicare |
$2,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
ANTEGRADE FEMORAL NAIL, RT, 9MM X 46CM
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12971691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.00 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: AlohaCare Medicaid |
$2,305.00
|
| Rate for Payer: AlohaCare Medicare |
$2,305.00
|
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Devoted Health Medicare |
$2,535.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Humana Medicare |
$2,305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,351.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,305.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,305.00
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
ANTEGRADE FEMORAL NAIL, RT, 9MM X 46CM
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12971691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.60 |
| Max. Negotiated Rate |
$4,471.70 |
| Rate for Payer: Cash Price |
$2,996.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,227.00
|
| Rate for Payer: Health Management Network Commercial |
$3,918.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,149.00
|
| Rate for Payer: MDX Hawaii PPO |
$4,471.70
|
| Rate for Payer: University Health Alliance Commercial |
$2,581.60
|
|
|
Antibody Id. (Elution)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
12499852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$199.75 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
|
|
Antibody Id. (Elution)
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 86860
|
| Hospital Charge Code |
12499852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: AlohaCare Medicaid |
$117.50
|
| Rate for Payer: AlohaCare Medicare |
$117.50
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Cash Price |
$152.75
|
| Rate for Payer: Devoted Health Medicare |
$129.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$117.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$199.75
|
| Rate for Payer: Humana Medicare |
$117.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$211.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$119.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$117.50
|
| Rate for Payer: MDX Hawaii PPO |
$227.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$117.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$117.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$117.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.29
|
|
|
Antibody Identification
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
12516212
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$457.76 |
| Rate for Payer: AlohaCare Medicaid |
$86.50
|
| Rate for Payer: AlohaCare Medicare |
$86.50
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Devoted Health Medicare |
$95.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Humana Medicare |
$86.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.50
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.50
|
| Rate for Payer: University Health Alliance Commercial |
$126.10
|
|
|
Antibody Identification
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
12516212
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
|
|
Antibody Screen FSI
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
8117847
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$118.00
|
| Rate for Payer: Cash Price |
$153.40
|
| Rate for Payer: Cash Price |
$153.40
|
| Rate for Payer: Devoted Health Medicare |
$129.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.77
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$118.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.00
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.88
|
|
|
Antibody Screen FSI
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 86850
|
| Hospital Charge Code |
8117847
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
.Antibody Titer to BBH FSI
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
8117848
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1,105.85 |
| Max. Negotiated Rate |
$1,261.97 |
| Rate for Payer: Cash Price |
$845.65
|
| Rate for Payer: Health Management Network Commercial |
$1,105.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,170.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,261.97
|
|
|
.Antibody Titer to BBH FSI
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
8117848
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$1,261.97 |
| Rate for Payer: AlohaCare Medicaid |
$650.50
|
| Rate for Payer: AlohaCare Medicare |
$650.50
|
| Rate for Payer: Cash Price |
$845.65
|
| Rate for Payer: Cash Price |
$845.65
|
| Rate for Payer: Devoted Health Medicare |
$715.55
|
| 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 |
$650.50
|
| 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 |
$1,105.85
|
| Rate for Payer: Humana Medicare |
$650.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,170.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$663.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$650.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,261.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$650.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$650.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$650.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
Anti-Centromere IgG Ab FSI
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
8117849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$102.50
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Devoted Health Medicare |
$112.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$102.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.50
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
Anti-Centromere IgG Ab FSI
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
8117849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
Anti-CMV IgG and IgM FSI
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
8521879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: AlohaCare Medicaid |
$121.00
|
| Rate for Payer: AlohaCare Medicare |
$121.00
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Devoted Health Medicare |
$133.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Humana Medicare |
$121.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.00
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Anti-CMV IgG and IgM FSI
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
8521879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.70 |
| Max. Negotiated Rate |
$234.74 |
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Health Management Network Commercial |
$205.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$217.80
|
| Rate for Payer: MDX Hawaii PPO |
$234.74
|
|
|
Anti Cyclic Citrullinated Peptide Ab IgG Anti-CCP FSI
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
8117843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$74.00
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$81.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.95
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.00
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
Anti Cyclic Citrullinated Peptide Ab IgG Anti-CCP FSI
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 86200
|
| Hospital Charge Code |
8117843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
Anti-DNA DS Ab FSI
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
8117850
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$133.45 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
|
|
Anti-DNA DS Ab FSI
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
8117850
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: AlohaCare Medicaid |
$78.50
|
| Rate for Payer: AlohaCare Medicare |
$78.50
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Devoted Health Medicare |
$86.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.74
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.50
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.50
|
| Rate for Payer: University Health Alliance Commercial |
$35.52
|
|
|
Anti ENA (Smith, Smith/RNP) Panel FSI
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
8117844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
Anti ENA (Smith, Smith/RNP) Panel FSI
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
8117844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$102.50
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Devoted Health Medicare |
$112.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$102.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.50
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
Anti Mullerian Hormone, Female FSI
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
8117845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: Cash Price |
$153.40
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
|
|
Anti Mullerian Hormone, Female FSI
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
8117845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$228.92 |
| Rate for Payer: AlohaCare Medicaid |
$118.00
|
| Rate for Payer: AlohaCare Medicare |
$118.00
|
| Rate for Payer: Cash Price |
$153.40
|
| Rate for Payer: Cash Price |
$153.40
|
| Rate for Payer: Devoted Health Medicare |
$129.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$200.60
|
| Rate for Payer: Humana Medicare |
$118.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$212.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$120.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.00
|
| Rate for Payer: MDX Hawaii PPO |
$228.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
Anti Neutrophilic Cytoplasmic Antibody ANCA FSI
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
8117846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: AlohaCare Medicaid |
$43.50
|
| Rate for Payer: AlohaCare Medicare |
$43.50
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Devoted Health Medicare |
$47.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Humana Medicare |
$43.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.50
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.50
|
| Rate for Payer: University Health Alliance Commercial |
$63.41
|
|
|
Anti Neutrophilic Cytoplasmic Antibody ANCA FSI
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
8117846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Health Management Network Commercial |
$73.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$84.39
|
|
