|
87510 - Gardner Vag DNA Dir Probe
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 87510
|
| Hospital Charge Code |
8728877
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: AlohaCare Medicaid |
$112.50
|
| Rate for Payer: AlohaCare Medicare |
$112.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Devoted Health Medicare |
$123.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$29.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Humana Medicare |
$112.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$51.84
|
|
|
87529 HSV Subtype by PCR FSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
11240913
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: AlohaCare Medicaid |
$196.00
|
| Rate for Payer: AlohaCare Medicare |
$196.00
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Devoted Health Medicare |
$215.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$196.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Humana Medicare |
$196.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.00
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$196.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
87529 HSV Subtype by PCR FSI
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
11240913
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
|
|
87634
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
13416109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: AlohaCare Medicaid |
$38.50
|
| Rate for Payer: AlohaCare Medicare |
$38.50
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Devoted Health Medicare |
$42.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.84
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$87.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$96.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Humana Medicare |
$38.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.50
|
| Rate for Payer: MDX Hawaii PPO |
$74.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.50
|
| Rate for Payer: University Health Alliance Commercial |
$160.32
|
|
|
87634
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87634
|
| Hospital Charge Code |
13416109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$74.69 |
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.30
|
| Rate for Payer: MDX Hawaii PPO |
$74.69
|
|
|
87660 - Trichomonas Vag Direct
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 87660
|
| Hospital Charge Code |
8728879
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: AlohaCare Medicaid |
$103.00
|
| Rate for Payer: AlohaCare Medicare |
$103.00
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Devoted Health Medicare |
$113.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.17
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$25.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: Humana Medicare |
$103.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.00
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.00
|
| Rate for Payer: University Health Alliance Commercial |
$51.84
|
|
|
87660 - Trichomonas Vag Direct
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 87660
|
| Hospital Charge Code |
8728879
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: Cash Price |
$133.90
|
| Rate for Payer: Health Management Network Commercial |
$175.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.40
|
| Rate for Payer: MDX Hawaii PPO |
$199.82
|
|
|
87804 Rapid Flu Rfx CoV-2
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 87804 RT,26
|
| Hospital Charge Code |
8860997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$67.00
|
| Rate for Payer: AlohaCare Medicare |
$67.00
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$73.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.30
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$67.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.00
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
87804 Rapid Flu Rfx CoV-2
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 87804 RT,26
|
| Hospital Charge Code |
8860997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
87804 Rapid Flu Rfx PCR Rfx CoV-2
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 87804 RT,26
|
| Hospital Charge Code |
8860998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$67.00
|
| Rate for Payer: AlohaCare Medicare |
$67.00
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Devoted Health Medicare |
$73.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.30
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$67.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.00
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
87804 Rapid Flu Rfx PCR Rfx CoV-2
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 87804 RT,26
|
| Hospital Charge Code |
8860998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
87807 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 87807 QW
|
| Hospital Charge Code |
9697239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: AlohaCare Medicaid |
$16.58
|
| Rate for Payer: AlohaCare Medicare |
$13.10
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$14.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.75
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.10
|
|
|
87880 Infectious agent antigen detection by immunoassay with direct optical observation; Streptococc
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 87880 QW
|
| Hospital Charge Code |
8287621
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$16.58
|
| Rate for Payer: AlohaCare Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Devoted Health Medicare |
$18.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.08
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.84
|
| 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 |
$339.46
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| 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 |
$246.64
|
|
|
88312 AP Bill Special Stains Group I
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 88312 TC
|
| Hospital Charge Code |
295362
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$232.90 |
| Max. Negotiated Rate |
$265.78 |
| Rate for Payer: Cash Price |
$178.10
|
| Rate for Payer: Health Management Network Commercial |
$232.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.60
|
| Rate for Payer: MDX Hawaii PPO |
$265.78
|
|
|
88312 AP Bill Special Stains Group I
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 88312 TC
|
| Hospital Charge Code |
295362
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$265.78 |
| Rate for Payer: AlohaCare Medicaid |
$137.00
|
| Rate for Payer: AlohaCare Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$178.10
|
| Rate for Payer: Cash Price |
$178.10
|
| Rate for Payer: Devoted Health Medicare |
$150.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$32.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$260.30
|
| Rate for Payer: Health Management Network Commercial |
$232.90
|
| Rate for Payer: Humana Medicare |
$137.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.00
|
| Rate for Payer: MDX Hawaii PPO |
$265.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.00
|
| Rate for Payer: University Health Alliance Commercial |
$138.31
|
|
|
88313 AP Bill Special Stains Group II
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 88313 TC
|
| Hospital Charge Code |
295364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$232.90 |
| Max. Negotiated Rate |
$265.78 |
| Rate for Payer: Cash Price |
$178.10
|
| Rate for Payer: Health Management Network Commercial |
$232.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.60
|
| Rate for Payer: MDX Hawaii PPO |
$265.78
|
|
|
88313 AP Bill Special Stains Group II
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 88313 TC
|
| Hospital Charge Code |
295364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$265.78 |
| Rate for Payer: AlohaCare Medicaid |
$137.00
|
| Rate for Payer: AlohaCare Medicare |
$137.00
|
| Rate for Payer: Cash Price |
$178.10
|
| Rate for Payer: Cash Price |
$178.10
|
| Rate for Payer: Devoted Health Medicare |
$150.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$137.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$260.30
|
| Rate for Payer: Health Management Network Commercial |
$232.90
|
| Rate for Payer: Humana Medicare |
$137.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$137.00
|
| Rate for Payer: MDX Hawaii PPO |
$265.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$137.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$137.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$137.00
|
| Rate for Payer: University Health Alliance Commercial |
$122.28
|
|
|
89051 Cell Count Body Fluid with Diff
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
10047281
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: AlohaCare Medicaid |
$34.50
|
| Rate for Payer: AlohaCare Medicare |
$34.50
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Devoted Health Medicare |
$37.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Humana Medicare |
$34.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.50
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.50
|
| Rate for Payer: University Health Alliance Commercial |
$14.24
|
|
|
89051 Cell Count Body Fluid with Diff
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
10047281
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Cash Price |
$44.85
|
| Rate for Payer: Health Management Network Commercial |
$58.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.10
|
| Rate for Payer: MDX Hawaii PPO |
$66.93
|
|
|
90378 Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
8041196
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$1,618.16 |
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,618.16
|
| Rate for Payer: Health Management Network Commercial |
$408.00
|
|
|
90380 VFC Beyfortus RSV Vaccine 0.5ml dose
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 90380
|
| Hospital Charge Code |
12124361
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Management Network Commercial |
$0.01
|
|
|
90381 VFC Beyfortus RSV Vaccine 1.0 ml dose
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
12124362
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Health Management Network Commercial |
$0.01
|
|
|
90460 Immunization counseling and administration, through 18 yrs; first or only component
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
8041197
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: AlohaCare Medicare |
$25.16
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$27.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.16
|
|
|
90460 VFC Immunization counseling and administration, through 18 yrs; first or only component
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 90460
|
| Hospital Charge Code |
8314307
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$30.19 |
| Rate for Payer: AlohaCare Medicare |
$25.16
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Devoted Health Medicare |
$27.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$23.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.16
|
|
|
90461 Immunization counseling and administration, through 18 yrs; each additional vaccine component
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 90461
|
| Hospital Charge Code |
8041198
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: AlohaCare Medicare |
$8.86
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$9.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.86
|
|
