|
83605 Lactic Acid POC
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 83605
|
| Hospital Charge Code |
9364741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: AlohaCare Medicaid |
$79.50
|
| Rate for Payer: AlohaCare Medicare |
$79.50
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Devoted Health Medicare |
$87.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.57
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Humana Medicare |
$79.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.50
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.50
|
| Rate for Payer: University Health Alliance Commercial |
$27.60
|
|
|
83655-Heavy Metals Panel 3
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
12539015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$6.50
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Devoted Health Medicare |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$6.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.50
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.28
|
|
|
83655-Heavy Metals Panel 3
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
12539015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
83825-Heavy Metals Panel 3
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
12517849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$9.00
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Devoted Health Medicare |
$9.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.26
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$9.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.00
|
| Rate for Payer: University Health Alliance Commercial |
$42.03
|
|
|
83825-Heavy Metals Panel 3
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
12517849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
83992- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 83992
|
| Hospital Charge Code |
9700532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$537.38 |
| Rate for Payer: AlohaCare Medicaid |
$277.00
|
| Rate for Payer: AlohaCare Medicare |
$277.00
|
| Rate for Payer: Cash Price |
$360.10
|
| Rate for Payer: Cash Price |
$360.10
|
| Rate for Payer: Devoted Health Medicare |
$304.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$20.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$526.30
|
| Rate for Payer: Health Management Network Commercial |
$470.90
|
| Rate for Payer: Humana Medicare |
$277.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$498.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$282.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$277.00
|
| Rate for Payer: MDX Hawaii PPO |
$537.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$277.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$277.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$38.00
|
|
|
83992- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 83992
|
| Hospital Charge Code |
9700532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$470.90 |
| Max. Negotiated Rate |
$537.38 |
| Rate for Payer: Cash Price |
$360.10
|
| Rate for Payer: Health Management Network Commercial |
$470.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$498.60
|
| Rate for Payer: MDX Hawaii PPO |
$537.38
|
|
|
84132 Potassium POC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 84132 QW
|
| Hospital Charge Code |
8343992
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: AlohaCare Medicaid |
$115.00
|
| Rate for Payer: AlohaCare Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$126.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.76
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Humana Medicare |
$115.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.00
|
| Rate for Payer: University Health Alliance Commercial |
$11.88
|
|
|
84132 Potassium POC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 84132 QW
|
| Hospital Charge Code |
8343992
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
|
84295 Sodium POC
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 84295 QW
|
| Hospital Charge Code |
8343994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: AlohaCare Medicaid |
$115.00
|
| Rate for Payer: AlohaCare Medicare |
$115.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$126.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.81
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Humana Medicare |
$115.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.00
|
| Rate for Payer: University Health Alliance Commercial |
$12.43
|
|
|
84295 Sodium POC
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 84295 QW
|
| Hospital Charge Code |
8343994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$223.10 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.00
|
| Rate for Payer: MDX Hawaii PPO |
$223.10
|
|
|
84302
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
13407393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$2.50
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Devoted Health Medicare |
$2.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.79
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.86
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$2.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.56
|
|
|
84302
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
13407393
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
84520 Blood Urea Nitrogen BUN POC
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 84520 QW
|
| Hospital Charge Code |
8343989
|
|
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
|
|
|
84520 Blood Urea Nitrogen BUN POC
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 84520 QW
|
| Hospital Charge Code |
8343989
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| 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 |
$5.45
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.95
|
| 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 |
$5.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.00
|
| Rate for Payer: University Health Alliance Commercial |
$10.19
|
|
|
85018 BLOOD COUNT HEMOGLOBIN
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
12373475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: AlohaCare Medicaid |
$13.50
|
| Rate for Payer: AlohaCare Medicare |
$13.50
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Devoted Health Medicare |
$14.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.37
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.50
|
| Rate for Payer: University Health Alliance Commercial |
$6.12
|
|
|
85018 BLOOD COUNT HEMOGLOBIN
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
12373475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Health Management Network Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.30
|
| Rate for Payer: MDX Hawaii PPO |
$26.19
|
|
|
85610 PT/INR (POC)
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
11484610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$33.50
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$36.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.29
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$33.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.50
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.50
|
| Rate for Payer: University Health Alliance Commercial |
$10.16
|
|
|
85610 PT/INR (POC)
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
11484610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
86036
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
13407391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$6.50
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Devoted Health Medicare |
$7.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$6.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.50
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
|
86036
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
13407391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$8.45
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
86235-MyoMarker 3 Profile
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
12539043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$46.36 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$10.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Devoted Health Medicare |
$11.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.93
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.00
|
| Rate for Payer: University Health Alliance Commercial |
$46.36
|
|
|
86235-MyoMarker 3 Profile
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
12539043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
86325 Sjogrens Ab KSO
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
10017302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.53 |
| 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: Cash Price |
$130.65
|
| Rate for Payer: Devoted Health Medicare |
$110.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.13
|
| 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 Medicaid |
$22.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.50
|
| Rate for Payer: University Health Alliance Commercial |
$57.79
|
|
|
86325 Sjogrens Ab KSO
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
HCPCS 86325
|
| Hospital Charge Code |
10017302
|
|
Hospital Revenue Code
|
310
|
| 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
|
|
