|
Bill Only Cytopath Scrn & Interp
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
8409272
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.75 |
| 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 |
$33.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$105.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.75
|
| 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 |
$33.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$105.00
|
| Rate for Payer: University Health Alliance Commercial |
$57.11
|
|
|
Bill Only Cytopath Scrn & Interp
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 88160 TC
|
| Hospital Charge Code |
8409272
|
|
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
|
|
|
Bill Only dRVVT Mix Bill
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
8301489
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: AlohaCare Medicaid |
$55.00
|
| Rate for Payer: AlohaCare Medicare |
$55.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Devoted Health Medicare |
$60.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.58
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Humana Medicare |
$55.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.00
|
| Rate for Payer: University Health Alliance Commercial |
$24.73
|
|
|
Bill Only dRVVT Mix Bill
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 85613
|
| Hospital Charge Code |
8301489
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.50 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Health Management Network Commercial |
$93.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.70
|
|
|
Bill Only Ethamb Resist by Seq
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
8301475
|
|
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 Ethamb Resist by Seq
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
8301475
|
|
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 Flow Cytometry Cell Cycle
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS 88182 TC
|
| Hospital Charge Code |
8409274
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: AlohaCare Medicaid |
$206.00
|
| Rate for Payer: AlohaCare Medicare |
$206.00
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Devoted Health Medicare |
$226.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$206.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$53.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$391.40
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Humana Medicare |
$206.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$210.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.00
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$206.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$206.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$206.00
|
| Rate for Payer: University Health Alliance Commercial |
$143.04
|
|
|
Bill Only Flow Cytometry Cell Cycle
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS 88182 TC
|
| Hospital Charge Code |
8409274
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: Cash Price |
$267.80
|
| Rate for Payer: Health Management Network Commercial |
$350.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.80
|
| Rate for Payer: MDX Hawaii PPO |
$399.64
|
|
|
Bill Only Fungal ID DNA Seq
|
Facility
|
IP
|
$1,072.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
8301469
|
|
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 Fungal ID DNA Seq
|
Facility
|
OP
|
$1,072.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
8301469
|
|
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 Glucose, 1 Hr Post Prand., Pregnancy
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
12927333
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: AlohaCare Medicaid |
$23.00
|
| Rate for Payer: AlohaCare Medicare |
$23.00
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Devoted Health Medicare |
$25.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Humana Medicare |
$23.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.00
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.00
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Bill Only Glucose, 1 Hr Post Prand., Pregnancy
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
12927333
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
|
|
Bill Only Glucose, 2 Hour Post Prandial
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
12925324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: AlohaCare Medicaid |
$24.00
|
| Rate for Payer: AlohaCare Medicare |
$24.00
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$26.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Humana Medicare |
$24.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.00
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.00
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Bill Only Glucose, 2 Hour Post Prandial
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 82950
|
| Hospital Charge Code |
12925324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.20
|
| Rate for Payer: MDX Hawaii PPO |
$46.56
|
|
|
Bill Only HCG Qual, Reflex to Quant
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
12925322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$44.50
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$48.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.52
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$44.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.50
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.50
|
| Rate for Payer: University Health Alliance Commercial |
$19.41
|
|
|
Bill Only HCG Qual, Reflex to Quant
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 84703
|
| Hospital Charge Code |
12925322
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
Bill Only Hexagonal Phase Charge
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
8301492
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
Bill Only Hexagonal Phase Charge
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 85597
|
| Hospital Charge Code |
8301492
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.98 |
| 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 |
$24.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.98
|
| 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 |
$24.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.50
|
| Rate for Payer: University Health Alliance Commercial |
$46.47
|
|
|
Bill Only HSV 1 Amp Probe CSF/Swab FSI
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
8418342
|
|
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 HSV 1 Amp Probe CSF/Swab FSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
8418342
|
|
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 |
$46.44
|
| 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 |
$48.76
|
| 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 |
$46.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
Bill Only Immunofluorescence Each
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 88346 TC
|
| Hospital Charge Code |
8409280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$913.75 |
| Max. Negotiated Rate |
$1,042.75 |
| Rate for Payer: Cash Price |
$698.75
|
| Rate for Payer: Health Management Network Commercial |
$913.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$967.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,042.75
|
|
|
Bill Only Immunofluorescence Each
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 88346 TC
|
| Hospital Charge Code |
8409280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.51 |
| Max. Negotiated Rate |
$1,042.75 |
| Rate for Payer: AlohaCare Medicaid |
$537.50
|
| Rate for Payer: AlohaCare Medicare |
$537.50
|
| Rate for Payer: Cash Price |
$698.75
|
| Rate for Payer: Cash Price |
$698.75
|
| Rate for Payer: Devoted Health Medicare |
$591.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$60.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$537.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,021.25
|
| Rate for Payer: Health Management Network Commercial |
$913.75
|
| Rate for Payer: Humana Medicare |
$537.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$967.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$548.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$537.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,042.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$537.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$537.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$537.50
|
| Rate for Payer: University Health Alliance Commercial |
$117.20
|
|
|
Bill Only Immunofluorscence Add
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 88350 TC
|
| Hospital Charge Code |
8409282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: AlohaCare Medicaid |
$282.00
|
| Rate for Payer: AlohaCare Medicare |
$282.00
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Devoted Health Medicare |
$310.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$30.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$282.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$535.80
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Humana Medicare |
$282.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$287.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$282.00
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$282.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$282.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$282.00
|
| Rate for Payer: University Health Alliance Commercial |
$94.24
|
|
|
Bill Only Immunofluorscence Add
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 88350 TC
|
| Hospital Charge Code |
8409282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$479.40 |
| Max. Negotiated Rate |
$547.08 |
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Health Management Network Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$507.60
|
| Rate for Payer: MDX Hawaii PPO |
$547.08
|
|
|
Bill Only Immunohistochem Each Add
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
HCPCS 88341 TC
|
| Hospital Charge Code |
8409278
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: AlohaCare Medicaid |
$218.50
|
| Rate for Payer: AlohaCare Medicare |
$218.50
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Cash Price |
$284.05
|
| Rate for Payer: Devoted Health Medicare |
$240.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$218.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$415.15
|
| Rate for Payer: Health Management Network Commercial |
$371.45
|
| Rate for Payer: Humana Medicare |
$218.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$393.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$222.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$218.50
|
| Rate for Payer: MDX Hawaii PPO |
$423.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$218.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$218.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$218.50
|
| Rate for Payer: University Health Alliance Commercial |
$99.23
|
|
