|
Bill Only Chloride, 24 Hr Urine
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
12925321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: AlohaCare Medicaid |
$25.50
|
| Rate for Payer: AlohaCare Medicare |
$25.50
|
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: Devoted Health Medicare |
$28.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Humana Medicare |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.50
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
Bill Only Clindamycin Induct Fee
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301482
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
Bill Only Clindamycin Induct Fee
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301482
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$20.50
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$22.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Humana Medicare |
$20.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.50
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
Bill Only Clindamycin Induct X2
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$20.50
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$22.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Humana Medicare |
$20.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.50
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
Bill Only Clindamycin Induct X2
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
Bill only - Clonazepam
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
12517667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$339.50 |
| Rate for Payer: AlohaCare Medicaid |
$175.00
|
| Rate for Payer: AlohaCare Medicare |
$175.00
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Devoted Health Medicare |
$192.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Humana Medicare |
$175.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.00
|
| Rate for Payer: MDX Hawaii PPO |
$339.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.00
|
| Rate for Payer: University Health Alliance Commercial |
$35.39
|
|
|
Bill only - Clonazepam
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
12517667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$339.50 |
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.00
|
| Rate for Payer: MDX Hawaii PPO |
$339.50
|
|
|
Bill Only CMV Amp Probe FSI
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
8418341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
|
|
Bill Only CMV Amp Probe FSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
8418341
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: AlohaCare Medicaid |
$196.00
|
| Rate for Payer: AlohaCare Medicare |
$196.00
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Devoted Health Medicare |
$215.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$196.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Humana Medicare |
$196.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.00
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$196.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
Bill Only Consult & Rpt On Ref Slid
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 88323 TC
|
| Hospital Charge Code |
8409277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$378.30 |
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Health Management Network Commercial |
$331.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$351.00
|
| Rate for Payer: MDX Hawaii PPO |
$378.30
|
|
|
Bill Only Consult & Rpt On Ref Slid
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 88323 TC
|
| Hospital Charge Code |
8409277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$378.30 |
| Rate for Payer: AlohaCare Medicaid |
$195.00
|
| Rate for Payer: AlohaCare Medicare |
$195.00
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Devoted Health Medicare |
$214.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$195.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$370.50
|
| Rate for Payer: Health Management Network Commercial |
$331.50
|
| Rate for Payer: Humana Medicare |
$195.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$351.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$198.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$195.00
|
| Rate for Payer: MDX Hawaii PPO |
$378.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$195.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$195.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$195.00
|
| Rate for Payer: University Health Alliance Commercial |
$119.58
|
|
|
Bill Only COVID19 HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 99001
|
| Hospital Charge Code |
8951361
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.85 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Health Management Network Commercial |
$170.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.90
|
| Rate for Payer: MDX Hawaii PPO |
$194.97
|
|
|
Bill Only COVID19 HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 99001
|
| Hospital Charge Code |
8951361
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$194.97 |
| Rate for Payer: AlohaCare Medicaid |
$100.50
|
| Rate for Payer: AlohaCare Medicare |
$100.50
|
| Rate for Payer: Cash Price |
$130.65
|
| Rate for Payer: Devoted Health Medicare |
$110.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.95
|
| Rate for Payer: Health Management Network Commercial |
$170.85
|
| Rate for Payer: Humana Medicare |
$100.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.50
|
| Rate for Payer: MDX Hawaii PPO |
$194.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.50
|
| Rate for Payer: University Health Alliance Commercial |
$146.51
|
|
|
Bill Only COVID19 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
8951360
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
|
Bill Only COVID19 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
8951360
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$44.00
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Devoted Health Medicare |
$48.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.60
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$44.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.00
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.00
|
| Rate for Payer: University Health Alliance Commercial |
$64.14
|
|
|
Bill Only Credit Shiga Toxin
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
8301486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
Bill Only Credit Shiga Toxin
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
8301486
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$76.45
|
| 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 |
$69.50
|
| 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 |
$118.15
|
| Rate for Payer: Humana Medicare |
$69.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.50
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only Cult Anerob ID x1
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
8301478
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
Bill Only Cult Anerob ID x1
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
8301478
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$49.00
|
| Rate for Payer: AlohaCare Medicare |
$49.00
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$53.90
|
| 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 |
$49.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$49.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.00
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.00
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
Bill Only Cult Anerob ID x2
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
8301479
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$49.00
|
| Rate for Payer: AlohaCare Medicare |
$49.00
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$53.90
|
| 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 |
$49.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$49.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.00
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.00
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
Bill Only Cult Anerob ID x2
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
8301479
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
Bill Only Cult Anerob ID x3
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
8301480
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: AlohaCare Medicaid |
$49.00
|
| Rate for Payer: AlohaCare Medicare |
$49.00
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Devoted Health Medicare |
$53.90
|
| 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 |
$49.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Humana Medicare |
$49.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.00
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$49.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$49.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$49.00
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
Bill Only Cult Anerob ID x3
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
HCPCS 87076
|
| Hospital Charge Code |
8301480
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
|
|
Bill Only Cytopath Prep Scrn Interp
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 88161 TC
|
| Hospital Charge Code |
8409273
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: AlohaCare Medicaid |
$105.00
|
| Rate for Payer: AlohaCare Medicare |
$105.00
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Devoted Health Medicare |
$115.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$199.50
|
| Rate for Payer: Health Management Network Commercial |
$178.50
|
| Rate for Payer: Humana Medicare |
$105.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$105.00
|
| Rate for Payer: MDX Hawaii PPO |
$203.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$105.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.00
|
| Rate for Payer: University Health Alliance Commercial |
$66.71
|
|
|
Bill Only Cytopath Prep Scrn Interp
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 88161 TC
|
| Hospital Charge Code |
8409273
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$203.70 |
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Health Management Network Commercial |
$178.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$189.00
|
| Rate for Payer: MDX Hawaii PPO |
$203.70
|
|
