|
Allergen Casein, IgE FSI
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 86008
|
| Hospital Charge Code |
8117785
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Health Management Network Commercial |
$66.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.20
|
| Rate for Payer: MDX Hawaii PPO |
$75.66
|
|
|
Allergen Casein, IgE FSI
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 86008
|
| Hospital Charge Code |
8117785
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$75.66 |
| Rate for Payer: AlohaCare Medicaid |
$39.00
|
| Rate for Payer: AlohaCare Medicare |
$39.00
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Devoted Health Medicare |
$42.90
|
| 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 |
$39.00
|
| 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 |
$66.30
|
| Rate for Payer: Humana Medicare |
$39.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.00
|
| Rate for Payer: MDX Hawaii PPO |
$75.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.00
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
|
|
Allergen Cat Epithelium, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117786
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Cat Epithelium, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117786
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Cheddar Cheese, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117787
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Cheddar Cheese, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117787
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Chicken Feathers, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Chicken Feathers, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117788
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Chicken, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117789
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Chicken, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117789
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Cladosporium herbarum, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117790
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Cladosporium herbarum, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117790
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Clam, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117791
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Clam, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117791
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Cockroach, German, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Cockroach, German, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117792
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Cocoa/Chocolate, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Cocoa/Chocolate, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117793
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Cow Dander, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen Cow Dander, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Crab, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Crab, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen D. farinae, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Allergen D. farinae, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
|
Allergen Dog Dander, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$74.50
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Devoted Health Medicare |
$81.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.22
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$74.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.50
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.50
|
| Rate for Payer: University Health Alliance Commercial |
$13.51
|
|
