|
Bill Only Reptilase Time
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 85635
|
| Hospital Charge Code |
8301485
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$48.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$52.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.85
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$48.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.00
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.00
|
| Rate for Payer: University Health Alliance Commercial |
$25.46
|
|
|
Bill Only Sensitivity Mic KSO FSI
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
8453178
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
Bill Only Sensitivity Mic KSO FSI
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
8453178
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$63.50
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$69.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$63.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.50
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
Bill Only SINGL AG AB ID CII LMX
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS 86833
|
| Hospital Charge Code |
8301502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$1,052.45 |
| Rate for Payer: AlohaCare Medicaid |
$542.50
|
| Rate for Payer: AlohaCare Medicare |
$542.50
|
| Rate for Payer: Cash Price |
$705.25
|
| Rate for Payer: Cash Price |
$705.25
|
| Rate for Payer: Devoted Health Medicare |
$596.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$407.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$542.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$167.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$325.80
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Humana Medicare |
$542.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$553.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$542.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,052.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$542.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$542.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$542.50
|
| Rate for Payer: University Health Alliance Commercial |
$790.86
|
|
|
Bill Only SINGL AG AB ID CII LMX
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS 86833
|
| Hospital Charge Code |
8301502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$922.25 |
| Max. Negotiated Rate |
$1,052.45 |
| Rate for Payer: Cash Price |
$705.25
|
| Rate for Payer: Health Management Network Commercial |
$922.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$976.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,052.45
|
|
|
Bill Only SINGLE AG AB ID CI LMX
|
Facility
|
IP
|
$1,194.00
|
|
|
Service Code
|
HCPCS 86832
|
| Hospital Charge Code |
8301501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1,014.90 |
| Max. Negotiated Rate |
$1,158.18 |
| Rate for Payer: Cash Price |
$776.10
|
| Rate for Payer: Health Management Network Commercial |
$1,014.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,074.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,158.18
|
|
|
Bill Only SINGLE AG AB ID CI LMX
|
Facility
|
OP
|
$1,194.00
|
|
|
Service Code
|
HCPCS 86832
|
| Hospital Charge Code |
8301501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.64 |
| Max. Negotiated Rate |
$1,158.18 |
| Rate for Payer: AlohaCare Medicaid |
$597.00
|
| Rate for Payer: AlohaCare Medicare |
$597.00
|
| Rate for Payer: Cash Price |
$776.10
|
| Rate for Payer: Cash Price |
$776.10
|
| Rate for Payer: Devoted Health Medicare |
$656.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$404.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$597.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$184.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.75
|
| Rate for Payer: Health Management Network Commercial |
$1,014.90
|
| Rate for Payer: Humana Medicare |
$597.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,074.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$608.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$597.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,158.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$597.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$597.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$597.00
|
| Rate for Payer: University Health Alliance Commercial |
$322.64
|
|
|
Bill Only Suscept Enz Detect x1
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
8301490
|
|
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 Suscept Enz Detect x1
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 87185
|
| Hospital Charge Code |
8301490
|
|
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 Suscept Single Drug
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
8301476
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: AlohaCare Medicaid |
$83.50
|
| Rate for Payer: AlohaCare Medicare |
$83.50
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Devoted Health Medicare |
$91.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| Rate for Payer: Humana Medicare |
$83.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.50
|
| Rate for Payer: MDX Hawaii PPO |
$161.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
Bill Only Suscept Single Drug
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
8301476
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.95 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.30
|
| Rate for Payer: MDX Hawaii PPO |
$161.99
|
|
|
Bill Only Thrombin Time
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
8301487
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$51.85 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
|
|
Bill Only Thrombin Time
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 85670
|
| Hospital Charge Code |
8301487
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$30.50
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Cash Price |
$39.65
|
| Rate for Payer: Devoted Health Medicare |
$33.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.77
|
| Rate for Payer: Health Management Network Commercial |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.50
|
| Rate for Payer: MDX Hawaii PPO |
$59.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.50
|
| Rate for Payer: University Health Alliance Commercial |
$14.93
|
|
|
Bill Only Ur Cult ID
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
8301496
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
Bill Only Ur Cult ID
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 87088
|
| Hospital Charge Code |
8301496
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$43.00
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Cash Price |
$55.90
|
| Rate for Payer: Devoted Health Medicare |
$47.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.09
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$43.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.00
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.00
|
| Rate for Payer: University Health Alliance Commercial |
$19.74
|
|
|
Bill Only Urea Nitrogen, 24 Hr Urine
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
12929193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
|
|
Bill Only Urea Nitrogen, 24 Hr Urine
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 84540
|
| Hospital Charge Code |
12929193
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$38.80 |
| Rate for Payer: AlohaCare Medicaid |
$20.00
|
| Rate for Payer: AlohaCare Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Devoted Health Medicare |
$22.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.56
|
| Rate for Payer: Health Management Network Commercial |
$34.00
|
| Rate for Payer: Humana Medicare |
$20.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.00
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
Bill Only Urine Protein
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
12925323
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: AlohaCare Medicaid |
$28.00
|
| Rate for Payer: AlohaCare Medicare |
$28.00
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Devoted Health Medicare |
$30.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Humana Medicare |
$28.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.00
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.00
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
Bill Only Urine Protein
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
12925323
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Health Management Network Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.40
|
| Rate for Payer: MDX Hawaii PPO |
$54.32
|
|
|
Bill Only Vancomycin (Peak)
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
12927332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$162.96 |
| Rate for Payer: AlohaCare Medicaid |
$84.00
|
| Rate for Payer: AlohaCare Medicare |
$84.00
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$92.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.54
|
| Rate for Payer: Health Management Network Commercial |
$142.80
|
| Rate for Payer: Humana Medicare |
$84.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.00
|
| Rate for Payer: MDX Hawaii PPO |
$162.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.00
|
| Rate for Payer: University Health Alliance Commercial |
$35.02
|
|
|
Bill Only Vancomycin (Peak)
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
12927332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$162.96 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Health Management Network Commercial |
$142.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.20
|
| Rate for Payer: MDX Hawaii PPO |
$162.96
|
|
|
Bill Only Viral ID Charge
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
8301506
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
|
|
Bill Only Viral ID Charge
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 87253
|
| Hospital Charge Code |
8301506
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: AlohaCare Medicaid |
$75.00
|
| Rate for Payer: AlohaCare Medicare |
$75.00
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Devoted Health Medicare |
$82.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.20
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Humana Medicare |
$75.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.00
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.00
|
| Rate for Payer: University Health Alliance Commercial |
$23.18
|
|
|
Bill Only Yeast Id x1
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
8301497
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: AlohaCare Medicaid |
$73.50
|
| Rate for Payer: AlohaCare Medicare |
$73.50
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Devoted Health Medicare |
$80.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$14.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Humana Medicare |
$73.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.50
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.50
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
Bill Only Yeast Id x1
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
8301497
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$142.59 |
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: Health Management Network Commercial |
$124.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.30
|
| Rate for Payer: MDX Hawaii PPO |
$142.59
|
|
