|
Total CO2 iSTAT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 82374 QW
|
| Hospital Charge Code |
8293269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
|
|
Total CO2 iSTAT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 82374 QW
|
| Hospital Charge Code |
8293269
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: AlohaCare Medicaid |
$27.50
|
| Rate for Payer: AlohaCare Medicare |
$27.50
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Devoted Health Medicare |
$30.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.88
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Humana Medicare |
$27.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.64
|
|
|
Total Protein, Body Fluid FSI
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
8228929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
Total Protein, Body Fluid FSI
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
8228929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$31.50
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$34.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$31.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.50
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
Total Protein Creatinine w/Ratio Urine Random FSI
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
8118062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$260.93 |
| Rate for Payer: AlohaCare Medicaid |
$134.50
|
| Rate for Payer: AlohaCare Medicare |
$134.50
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Devoted Health Medicare |
$147.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$134.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.18
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Humana Medicare |
$134.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$134.50
|
| Rate for Payer: MDX Hawaii PPO |
$260.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$134.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$134.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.38
|
|
|
Total Protein Creatinine w/Ratio Urine Random FSI
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
8118062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$228.65 |
| Max. Negotiated Rate |
$260.93 |
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Health Management Network Commercial |
$228.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.10
|
| Rate for Payer: MDX Hawaii PPO |
$260.93
|
|
|
Total Protein, CSF FSI
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
8228928
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$31.50
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$34.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.69
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$31.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.50
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
Total Protein, CSF FSI
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84157
|
| Hospital Charge Code |
8228928
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
Total Protein FSI
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
8228927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
Total Protein FSI
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
8228927
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$31.50
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$34.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.67
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$31.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.50
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
Total Testosterone FSI
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
8118063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
Total Testosterone FSI
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
8118063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$147.00
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Cash Price |
$191.10
|
| Rate for Payer: Devoted Health Medicare |
$161.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.81
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$147.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.00
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.00
|
| Rate for Payer: University Health Alliance Commercial |
$66.75
|
|
|
Toxigenic C diff RTPCR FSI
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
9381907
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: AlohaCare Medicaid |
$220.00
|
| Rate for Payer: AlohaCare Medicare |
$220.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Devoted Health Medicare |
$242.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.27
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Humana Medicare |
$220.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$220.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$93.00
|
|
|
Toxigenic C diff RTPCR FSI
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 87493
|
| Hospital Charge Code |
9381907
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$426.80 |
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Health Management Network Commercial |
$374.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.00
|
| Rate for Payer: MDX Hawaii PPO |
$426.80
|
|
|
Toxoplasma Ab IgM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8208547
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
|
|
Toxoplasma Ab IgM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8208547
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: AlohaCare Medicaid |
$54.50
|
| Rate for Payer: AlohaCare Medicare |
$54.50
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Cash Price |
$70.85
|
| Rate for Payer: Devoted Health Medicare |
$59.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network Commercial |
$92.65
|
| Rate for Payer: Humana Medicare |
$54.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.50
|
| Rate for Payer: MDX Hawaii PPO |
$105.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.22
|
|
|
Toxoplasma IgG FSI
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
8404553
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$82.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$90.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Toxoplasma IgG FSI
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
8404553
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
Toxoplasma IgM FSI
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8404554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
Toxoplasma IgM FSI
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8404554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$82.50
|
| Rate for Payer: AlohaCare Medicare |
$82.50
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$90.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$82.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$82.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$148.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$82.50
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$82.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$82.50
|
| Rate for Payer: University Health Alliance Commercial |
$37.22
|
|
|
Toxoplasma Panel Adult FSI
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 86406
|
| Hospital Charge Code |
8118064
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Toxoplasma Panel Adult FSI
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 86406
|
| Hospital Charge Code |
8118064
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.64 |
| 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 |
$14.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.64
|
| 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 |
$14.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.51
|
|
|
Toxoplasmosis IgG and IgM FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
9904297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$62.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
|
Toxoplasmosis IgG and IgM FSI
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
9904297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
Toxoplasmosis IgG and IgM (Palo Alto) FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
10004696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$62.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.20
|
|
