|
Add-On Phosphatidylserine Ab IgG FSI
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
8335811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$92.00
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$101.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$92.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.00
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.00
|
| Rate for Payer: University Health Alliance Commercial |
$41.51
|
|
|
Add-On Phosphatidylserine Ab IgG FSI
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 86148
|
| Hospital Charge Code |
8335811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
Add-On Protein Tot Ur Random KSO
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
8301529
|
|
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 |
$3.69
|
| 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 |
$5.06
|
| 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 |
$3.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.47
|
|
|
Add-On Protein Tot Ur Random KSO
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 84156
|
| Hospital Charge Code |
8301529
|
|
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
|
|
|
Add-On PSA Free SO FSI
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
8301512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
Add-On PSA Free SO FSI
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 84154
|
| Hospital Charge Code |
8301512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$106.00
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$116.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.39
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$106.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.00
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.00
|
| Rate for Payer: University Health Alliance Commercial |
$47.55
|
|
|
Add-On Smear Complex Spec Stain KSO FSI
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
8301523
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$302.64 |
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Health Management Network Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$280.80
|
| Rate for Payer: MDX Hawaii PPO |
$302.64
|
|
|
Add-On Smear Complex Spec Stain KSO FSI
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
HCPCS 87209
|
| Hospital Charge Code |
8301523
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$302.64 |
| Rate for Payer: AlohaCare Medicaid |
$156.00
|
| Rate for Payer: AlohaCare Medicare |
$156.00
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Devoted Health Medicare |
$171.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$156.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.98
|
| Rate for Payer: Health Management Network Commercial |
$265.20
|
| Rate for Payer: Humana Medicare |
$156.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$280.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$156.00
|
| Rate for Payer: MDX Hawaii PPO |
$302.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$156.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$156.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$156.00
|
| Rate for Payer: University Health Alliance Commercial |
$46.45
|
|
|
Add-On T Cell Abs Cd4 Cd8 SO FSI
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
8301518
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.98 |
| 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 |
$64.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$58.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$68.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.98
|
| 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 |
$64.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.00
|
| Rate for Payer: University Health Alliance Commercial |
$121.45
|
|
|
Add-On T Cell Abs Cd4 Cd8 SO FSI
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 86360
|
| Hospital Charge Code |
8301518
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Add-On Thyroglobulin Ab SO FSI
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
8301507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$155.55 |
| Max. Negotiated Rate |
$177.51 |
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.70
|
| Rate for Payer: MDX Hawaii PPO |
$177.51
|
|
|
Add-On Thyroglobulin Ab SO FSI
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 86800
|
| Hospital Charge Code |
8301507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$177.51 |
| Rate for Payer: AlohaCare Medicaid |
$91.50
|
| Rate for Payer: AlohaCare Medicare |
$91.50
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Cash Price |
$118.95
|
| Rate for Payer: Devoted Health Medicare |
$100.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.91
|
| Rate for Payer: Health Management Network Commercial |
$155.55
|
| Rate for Payer: Humana Medicare |
$91.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.50
|
| Rate for Payer: MDX Hawaii PPO |
$177.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.50
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
Add-On Toxoplasma Ab IgG FSI
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
8335808
|
|
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
|
|
|
Add-On Toxoplasma Ab IgG FSI
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
8335808
|
|
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
|
|
|
Add-On Toxoplasma IgM KSO FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8301531
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.41 |
| 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 |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| 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 |
$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 |
$19.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.22
|
|
|
Add-On Toxoplasma IgM KSO FSI
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
8301531
|
|
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
|
|
|
Add On Typhus Fvr Ab IgM FSI
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
8335777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$211.46 |
| Rate for Payer: AlohaCare Medicaid |
$109.00
|
| Rate for Payer: AlohaCare Medicare |
$109.00
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Devoted Health Medicare |
$119.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.35
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Humana Medicare |
$109.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.00
|
| Rate for Payer: MDX Hawaii PPO |
$211.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$109.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.04
|
|
|
Add On Typhus Fvr Ab IgM FSI
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
8335777
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$185.30 |
| Max. Negotiated Rate |
$211.46 |
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Health Management Network Commercial |
$185.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$196.20
|
| Rate for Payer: MDX Hawaii PPO |
$211.46
|
|
|
Aden Deam Pleural Fld FSI
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
8404548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$48.50
|
| Rate for Payer: AlohaCare Medicare |
$48.50
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Devoted Health Medicare |
$53.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$48.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.50
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.50
|
| Rate for Payer: University Health Alliance Commercial |
$18.07
|
|
|
Aden Deam Pleural Fld FSI
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
8404548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
adenosine 6 mg/2mL vial [HHSC]
|
Facility
|
OP
|
$46.20
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
2500025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$44.81 |
| Rate for Payer: AlohaCare Medicaid |
$23.10
|
| Rate for Payer: AlohaCare Medicaid |
$36.54
|
| Rate for Payer: AlohaCare Medicaid |
$22.95
|
| Rate for Payer: AlohaCare Medicaid |
$22.37
|
| Rate for Payer: AlohaCare Medicare |
$22.37
|
| Rate for Payer: AlohaCare Medicare |
$22.95
|
| Rate for Payer: AlohaCare Medicare |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$36.54
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Devoted Health Medicare |
$25.25
|
| Rate for Payer: Devoted Health Medicare |
$25.41
|
| Rate for Payer: Devoted Health Medicare |
$24.61
|
| Rate for Payer: Devoted Health Medicare |
$40.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.43
|
| Rate for Payer: Health Management Network Commercial |
$62.12
|
| Rate for Payer: Health Management Network Commercial |
$39.02
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Humana Medicare |
$23.10
|
| Rate for Payer: Humana Medicare |
$36.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.37
|
| Rate for Payer: MDX Hawaii PPO |
$70.89
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$44.53
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.37
|
| Rate for Payer: University Health Alliance Commercial |
$53.27
|
| Rate for Payer: University Health Alliance Commercial |
$33.68
|
| Rate for Payer: University Health Alliance Commercial |
$32.61
|
| Rate for Payer: University Health Alliance Commercial |
$33.46
|
|
|
adenosine 6 mg/2mL vial [HHSC]
|
Facility
|
IP
|
$45.91
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
2500025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$44.53 |
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$39.02
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$62.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.32
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$70.89
|
| Rate for Payer: MDX Hawaii PPO |
$44.53
|
|
|
ADHESIVE, SWIFT SET WOUND CLOSURE
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
8274218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
ADHESIVE, SWIFT SET WOUND CLOSURE
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
8274218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.50 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: AlohaCare Medicaid |
$89.50
|
| Rate for Payer: AlohaCare Medicare |
$89.50
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$98.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$170.05
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$89.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.50
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.50
|
| Rate for Payer: University Health Alliance Commercial |
$130.47
|
|
|
ADL Training Charge
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 97535 GP,CQ
|
| Hospital Charge Code |
8111715
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$213.40 |
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.00
|
| Rate for Payer: MDX Hawaii PPO |
$213.40
|
|
