|
Bill Only 87502 Influenza A/B (Cepheid)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407405
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: AlohaCare Medicaid |
$152.50
|
| Rate for Payer: AlohaCare Medicare |
$152.50
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Devoted Health Medicare |
$167.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
| Rate for Payer: Humana Medicare |
$152.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.50
|
| Rate for Payer: MDX Hawaii PPO |
$295.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$152.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.50
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
Bill Only 87502 Influenza A/B/RSV, Real-time PCR
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$434.56 |
| Rate for Payer: AlohaCare Medicaid |
$224.00
|
| Rate for Payer: AlohaCare Medicare |
$224.00
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Devoted Health Medicare |
$246.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Humana Medicare |
$224.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$228.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.00
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$224.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.00
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
Bill Only 87502 Influenza A/B/RSV, Real-time PCR
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$434.56 |
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
|
|
Bill Only 87624 PAP and HPV Co-Testing
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
13395390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Devoted Health Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$88.36
|
|
|
Bill Only 87624 PAP and HPV Co-Testing
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
13395390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
Bill Only 87899 S. pneumoniae Antigen w/ CSF Culture & Gram Stain
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
13407410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: AlohaCare Medicaid |
$58.00
|
| Rate for Payer: AlohaCare Medicare |
$58.00
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Devoted Health Medicare |
$63.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Humana Medicare |
$58.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.00
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only 87899 S. pneumoniae Antigen w/ CSF Culture & Gram Stain
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
13407410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
|
|
Bill Only 87899 Strep pneumoniae Ag, Urine or CSF
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
13416127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
Bill Only 87899 Strep pneumoniae Ag, Urine or CSF
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
13416127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$30.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Devoted Health Medicare |
$33.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only 88142 Cytopath, Thin Prep & Man Screen
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
13407402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.40
|
| Rate for Payer: MDX Hawaii PPO |
$102.82
|
|
|
Bill Only 88142 Cytopath, Thin Prep & Man Screen
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
13407402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.26 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: AlohaCare Medicaid |
$53.00
|
| Rate for Payer: AlohaCare Medicare |
$53.00
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Devoted Health Medicare |
$58.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.26
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Humana Medicare |
$53.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.00
|
| Rate for Payer: MDX Hawaii PPO |
$102.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.00
|
| Rate for Payer: University Health Alliance Commercial |
$52.37
|
|
|
Bill Only Additional ID Method
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
8301471
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$59.50
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Devoted Health Medicare |
$65.45
|
| 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 |
$59.50
|
| 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 |
$101.15
|
| Rate for Payer: Humana Medicare |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.50
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.50
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
Bill Only Additional ID Method
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
8301471
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
|
|
Bill Only AFB Concentration
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
8301464
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
Bill Only AFB Concentration
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
8301464
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$55.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.68
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$50.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.00
|
| Rate for Payer: University Health Alliance Commercial |
$17.26
|
|
|
Bill Only AFB Cult AFB Stain
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
8301465
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: Cash Price |
$74.75
|
| 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
|
|
|
Bill Only AFB Cult AFB Stain
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 87116
|
| Hospital Charge Code |
8301465
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$111.55 |
| Rate for Payer: AlohaCare Medicaid |
$57.50
|
| Rate for Payer: AlohaCare Medicare |
$57.50
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Devoted Health Medicare |
$63.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.63
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.50
|
| Rate for Payer: MDX Hawaii PPO |
$111.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.50
|
| Rate for Payer: University Health Alliance Commercial |
$25.49
|
|
|
Bill Only AFB ID by Sequencing
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
8301463
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$1,039.84 |
| Rate for Payer: AlohaCare Medicaid |
$536.00
|
| Rate for Payer: AlohaCare Medicare |
$536.00
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Devoted Health Medicare |
$589.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$165.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$144.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$536.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.36
|
| Rate for Payer: Health Management Network Commercial |
$911.20
|
| Rate for Payer: Humana Medicare |
$536.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$546.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$536.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,039.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$536.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$536.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$165.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$536.00
|
| Rate for Payer: University Health Alliance Commercial |
$300.31
|
|
|
Bill Only AFB ID by Sequencing
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
8301463
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$911.20 |
| Max. Negotiated Rate |
$1,039.84 |
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Health Management Network Commercial |
$911.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$964.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,039.84
|
|
|
Bill Only AFB Id Chemical
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
8301467
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: AlohaCare Medicaid |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$70.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.61
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.00
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.00
|
| Rate for Payer: University Health Alliance Commercial |
$28.29
|
|
|
Bill Only AFB Id Chemical
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
8301467
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
Bill Only AFB ID MALDI-TOF MS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 87158
|
| Hospital Charge Code |
8301462
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.40
|
| Rate for Payer: MDX Hawaii PPO |
$102.82
|
|
|
Bill Only AFB ID MALDI-TOF MS
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 87158
|
| Hospital Charge Code |
8301462
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$102.82 |
| Rate for Payer: AlohaCare Medicaid |
$53.00
|
| Rate for Payer: AlohaCare Medicare |
$53.00
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Cash Price |
$68.90
|
| Rate for Payer: Devoted Health Medicare |
$58.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.74
|
| Rate for Payer: Health Management Network Commercial |
$90.10
|
| Rate for Payer: Humana Medicare |
$53.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$95.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$54.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.00
|
| Rate for Payer: MDX Hawaii PPO |
$102.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.00
|
| Rate for Payer: University Health Alliance Commercial |
$13.52
|
|
|
Bill Only AFB ID MTB DNA Probe
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
8301473
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: AlohaCare Medicaid |
$115.00
|
| Rate for Payer: AlohaCare Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$126.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Humana Medicare |
$115.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.00
|
| Rate for Payer: University Health Alliance Commercial |
$51.84
|
|
|
Bill Only AFB ID MTB DNA Probe
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
8301473
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
