|
77063 MG Mammo Screening Right w/ Tomo. Tech
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 77063 52,RT
|
| Hospital Charge Code |
12133856
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$113.48 |
| Rate for Payer: AlohaCare Medicaid |
$37.50
|
| Rate for Payer: AlohaCare Medicare |
$37.50
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Cash Price |
$48.75
|
| Rate for Payer: Devoted Health Medicare |
$41.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.25
|
| Rate for Payer: Health Management Network Commercial |
$63.75
|
| Rate for Payer: Humana Medicare |
$37.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.50
|
| Rate for Payer: MDX Hawaii PPO |
$72.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.50
|
| Rate for Payer: University Health Alliance Commercial |
$113.48
|
|
|
77063 MG Screening Tomo Bilateral
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
9886507
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$113.48 |
| Rate for Payer: AlohaCare Medicaid |
$46.50
|
| Rate for Payer: AlohaCare Medicare |
$46.50
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Devoted Health Medicare |
$51.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.35
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Humana Medicare |
$46.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.50
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.50
|
| Rate for Payer: University Health Alliance Commercial |
$113.48
|
|
|
77063 MG Screening Tomo Bilateral
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
9886507
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
|
|
77063 MG Screening Tomo Bilateral
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
9886507
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$65.82 |
| Rate for Payer: AlohaCare Medicaid |
$33.66
|
| Rate for Payer: AlohaCare Medicare |
$54.85
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$60.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.04
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.85
|
|
|
77063 MG Screening Tomo Unilateral
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
9886509
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
|
|
77063 MG Screening Tomo Unilateral
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
9886509
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.66 |
| Max. Negotiated Rate |
$65.82 |
| Rate for Payer: AlohaCare Medicaid |
$33.66
|
| Rate for Payer: AlohaCare Medicare |
$54.85
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$60.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.04
|
| Rate for Payer: Health Management Network Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.85
|
|
|
77063 MG Screening Tomo Unilateral
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
9886509
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$113.48 |
| Rate for Payer: AlohaCare Medicaid |
$46.50
|
| Rate for Payer: AlohaCare Medicare |
$46.50
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Cash Price |
$60.45
|
| Rate for Payer: Devoted Health Medicare |
$51.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.35
|
| Rate for Payer: Health Management Network Commercial |
$79.05
|
| Rate for Payer: Humana Medicare |
$46.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.50
|
| Rate for Payer: MDX Hawaii PPO |
$90.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.50
|
| Rate for Payer: University Health Alliance Commercial |
$113.48
|
|
|
77066 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI ProFee
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 77066 26
|
| Hospital Charge Code |
8103037
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$47.19 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$105.44
|
| Rate for Payer: AlohaCare Medicare |
$47.19
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$51.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$161.84
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
77067 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD ProFee
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 77067 26
|
| Hospital Charge Code |
8103038
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$85.27
|
| Rate for Payer: AlohaCare Medicare |
$35.74
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$39.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$156.36
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
78803 Rp Loclzj Tum Spect 1 Area
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
8882004
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$234.70 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: AlohaCare Medicaid |
$234.70
|
| Rate for Payer: AlohaCare Medicare |
$374.95
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Devoted Health Medicare |
$412.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$374.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$347.90
|
| Rate for Payer: Health Management Network Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$449.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$449.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$449.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$374.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$234.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$374.95
|
|
|
80158 Cyclospirine FSI
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
8857578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$101.00
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Devoted Health Medicare |
$111.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$24.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$101.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.00
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.00
|
| Rate for Payer: University Health Alliance Commercial |
$46.68
|
|
|
80158 Cyclospirine FSI
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80158
|
| Hospital Charge Code |
8857578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
80326- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80326
|
| Hospital Charge Code |
9700537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.48 |
| 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 |
$21.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.55
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
|
80326- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 80326
|
| Hospital Charge Code |
9700537
|
|
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
|
|
|
80345- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 80345
|
| Hospital Charge Code |
9700542
|
|
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
|
|
|
80345- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80345
|
| Hospital Charge Code |
9700542
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.80 |
| 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 |
$15.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.59
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
|
80347- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 80347
|
| Hospital Charge Code |
9700552
|
|
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
|
|
|
80347- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80347
|
| Hospital Charge Code |
9700552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.56 |
| 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 |
$25.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.84
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
|
80349- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
9700517
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.31 |
| 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 |
$18.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.23
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
|
80349- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
9700517
|
|
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
|
|
|
80353- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
9700522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.67 |
| 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 |
$21.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.76
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
|
80353- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
9700522
|
|
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
|
|
|
80358- Meconium Drug Screen with Reflex FSI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 80358
|
| Hospital Charge Code |
9700547
|
|
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
|
|
|
80358- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80358
|
| Hospital Charge Code |
9700547
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.67 |
| 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 |
$21.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.76
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
|
80364- Meconium Drug Screen with Reflex FSI
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 80364
|
| Hospital Charge Code |
9700527
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.89 |
| 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 |
$26.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$277.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.23
|
| 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 Medicare |
$277.00
|
| Rate for Payer: University Health Alliance Commercial |
$310.24
|
|
