|
Allergen Dog Dander, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117801
|
|
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. pteronyssinus, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117799
|
|
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 D. pteronyssinus, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117799
|
|
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 Duck Feathers, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117802
|
|
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 Duck Feathers, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117802
|
|
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 Egg, Whole, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117803
|
|
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 Egg, Whole, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117803
|
|
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 Gluten, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117806
|
|
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 Gluten, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117806
|
|
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 Goose Feathers, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117807
|
|
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 Goose Feathers, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117807
|
|
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 Honey Bee, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117809
|
|
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 Honey Bee, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117809
|
|
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 House Dust (Greer), IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117810
|
|
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 House Dust (Greer), IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117810
|
|
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 House Dust (H-S), IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117811
|
|
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 House Dust (H-S), IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117811
|
|
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 Johnson Grass, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117812
|
|
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 Johnson Grass, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117812
|
|
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 Latex, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117813
|
|
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 Latex, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117813
|
|
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 Lobster, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117814
|
|
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 Lobster, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117814
|
|
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 Mucor racemosus, IgE FSI
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117815
|
|
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 Mucor racemosus, IgE FSI
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
8117815
|
|
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
|
|
