|
Aden Deam Pleural Fld FSI
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
8404548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: AlohaCare Medicaid |
$48.50
|
| Rate for Payer: AlohaCare Medicare |
$48.50
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Devoted Health Medicare |
$53.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$48.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.50
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.50
|
| Rate for Payer: University Health Alliance Commercial |
$18.07
|
|
|
Aden Deam Pleural Fld FSI
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
8404548
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
adenosine 6 mg/2mL vial [HHSC]
|
Facility
|
OP
|
$46.20
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
2500025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$44.81 |
| Rate for Payer: AlohaCare Medicaid |
$23.10
|
| Rate for Payer: AlohaCare Medicaid |
$36.54
|
| Rate for Payer: AlohaCare Medicaid |
$22.95
|
| Rate for Payer: AlohaCare Medicaid |
$22.37
|
| Rate for Payer: AlohaCare Medicare |
$22.37
|
| Rate for Payer: AlohaCare Medicare |
$22.95
|
| Rate for Payer: AlohaCare Medicare |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$36.54
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Devoted Health Medicare |
$25.25
|
| Rate for Payer: Devoted Health Medicare |
$25.41
|
| Rate for Payer: Devoted Health Medicare |
$24.61
|
| Rate for Payer: Devoted Health Medicare |
$40.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.43
|
| Rate for Payer: Health Management Network Commercial |
$62.12
|
| Rate for Payer: Health Management Network Commercial |
$39.02
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Humana Medicare |
$22.95
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Humana Medicare |
$23.10
|
| Rate for Payer: Humana Medicare |
$36.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.37
|
| Rate for Payer: MDX Hawaii PPO |
$70.89
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$44.53
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$43.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.37
|
| Rate for Payer: University Health Alliance Commercial |
$53.27
|
| Rate for Payer: University Health Alliance Commercial |
$33.68
|
| Rate for Payer: University Health Alliance Commercial |
$32.61
|
| Rate for Payer: University Health Alliance Commercial |
$33.46
|
|
|
adenosine 6 mg/2mL vial [HHSC]
|
Facility
|
IP
|
$45.91
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
2500025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.02 |
| Max. Negotiated Rate |
$44.53 |
| Rate for Payer: Cash Price |
$29.84
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$39.02
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$62.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.32
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$70.89
|
| Rate for Payer: MDX Hawaii PPO |
$44.53
|
|
|
ADHESIVE, SWIFT SET WOUND CLOSURE
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
8274218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.50 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: AlohaCare Medicaid |
$89.50
|
| Rate for Payer: AlohaCare Medicare |
$89.50
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$98.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$170.05
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Humana Medicare |
$89.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.50
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.50
|
| Rate for Payer: University Health Alliance Commercial |
$130.47
|
|
|
ADHESIVE, SWIFT SET WOUND CLOSURE
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
8274218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.15 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$161.10
|
| Rate for Payer: MDX Hawaii PPO |
$173.63
|
|
|
ADL Training Charge
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 97535 GP,CQ
|
| Hospital Charge Code |
8111715
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$213.40 |
| Rate for Payer: AlohaCare Medicaid |
$110.00
|
| Rate for Payer: AlohaCare Medicare |
$110.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Devoted Health Medicare |
$121.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.00
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Humana Medicare |
$110.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.00
|
| Rate for Payer: MDX Hawaii PPO |
$213.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.00
|
| Rate for Payer: University Health Alliance Commercial |
$123.20
|
|
|
ADL Training Charge
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 97535 GP,CQ
|
| Hospital Charge Code |
8111715
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$213.40 |
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.00
|
| Rate for Payer: MDX Hawaii PPO |
$213.40
|
|
|
ADL Training Charges
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 97535 GP,CQ
|
| Hospital Charge Code |
8123821
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$213.40 |
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.00
|
| Rate for Payer: MDX Hawaii PPO |
$213.40
|
|
|
ADL Training Charges
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 97535 GP,CQ
|
| Hospital Charge Code |
8123821
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$213.40 |
| Rate for Payer: AlohaCare Medicaid |
$110.00
|
| Rate for Payer: AlohaCare Medicare |
$110.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Devoted Health Medicare |
$121.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$110.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.00
|
| Rate for Payer: Health Management Network Commercial |
$187.00
|
| Rate for Payer: Humana Medicare |
$110.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$110.00
|
| Rate for Payer: MDX Hawaii PPO |
$213.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$110.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$110.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$110.00
|
| Rate for Payer: University Health Alliance Commercial |
$123.20
|
|
|
ADNA w/ IFA Titer FSI
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
8117763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: AlohaCare Medicaid |
$78.50
|
| Rate for Payer: AlohaCare Medicare |
$78.50
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Devoted Health Medicare |
$86.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.74
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.50
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.50
|
| Rate for Payer: University Health Alliance Commercial |
$35.52
|
|
|
ADNA w/ IFA Titer FSI
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 86225
|
| Hospital Charge Code |
8117763
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$133.45 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$57,050.71
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$57,050.71 |
| Max. Negotiated Rate |
$57,050.71 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57,050.71
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$57,050.71
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$57,050.71 |
| Max. Negotiated Rate |
$57,050.71 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$57,050.71
|
|
|
Adrenocorticotropic Hormone ACTH FSI
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
8117764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
|
|
Adrenocorticotropic Hormone ACTH FSI
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
8117764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$210.49 |
| Rate for Payer: AlohaCare Medicaid |
$108.50
|
| Rate for Payer: AlohaCare Medicare |
$108.50
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Devoted Health Medicare |
$119.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$53.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$48.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.62
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Humana Medicare |
$108.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.50
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.50
|
| Rate for Payer: University Health Alliance Commercial |
$99.84
|
|
|
AEROSOL INHALATION TREATMENT CHARGE
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 94642
|
| Hospital Charge Code |
8243038
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$518.50 |
| Max. Negotiated Rate |
$591.70 |
| Rate for Payer: Cash Price |
$396.50
|
| Rate for Payer: Health Management Network Commercial |
$518.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$549.00
|
| Rate for Payer: MDX Hawaii PPO |
$591.70
|
|
|
AEROSOL INHALATION TREATMENT CHARGE
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 94642
|
| Hospital Charge Code |
8243038
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$591.70 |
| Rate for Payer: AlohaCare Medicaid |
$305.00
|
| Rate for Payer: AlohaCare Medicare |
$305.00
|
| Rate for Payer: Cash Price |
$396.50
|
| Rate for Payer: Cash Price |
$396.50
|
| Rate for Payer: Devoted Health Medicare |
$335.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$279.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$305.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$579.50
|
| Rate for Payer: Health Management Network Commercial |
$518.50
|
| Rate for Payer: Humana Medicare |
$305.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$549.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$311.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$305.00
|
| Rate for Payer: MDX Hawaii PPO |
$591.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$305.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$305.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$305.00
|
| Rate for Payer: University Health Alliance Commercial |
$341.60
|
|
|
AFB Each Isolate
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
8879045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
|
|
AFB Each Isolate
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
8879045
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.67 |
| Rate for Payer: AlohaCare Medicaid |
$55.50
|
| Rate for Payer: AlohaCare Medicare |
$55.50
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Cash Price |
$72.15
|
| Rate for Payer: Devoted Health Medicare |
$61.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.61
|
| Rate for Payer: Health Management Network Commercial |
$94.35
|
| Rate for Payer: Humana Medicare |
$55.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.50
|
| Rate for Payer: MDX Hawaii PPO |
$107.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.50
|
| Rate for Payer: University Health Alliance Commercial |
$28.29
|
|
|
AFB (MTB) PCR FSI
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
8669304
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$396.10 |
| Max. Negotiated Rate |
$452.02 |
| Rate for Payer: Cash Price |
$302.90
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$419.40
|
| Rate for Payer: MDX Hawaii PPO |
$452.02
|
|
|
AFB (MTB) PCR FSI
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS 87556
|
| Hospital Charge Code |
8669304
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$452.02 |
| Rate for Payer: AlohaCare Medicaid |
$233.00
|
| Rate for Payer: AlohaCare Medicare |
$233.00
|
| Rate for Payer: Cash Price |
$302.90
|
| Rate for Payer: Cash Price |
$302.90
|
| Rate for Payer: Devoted Health Medicare |
$256.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$52.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$233.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.68
|
| Rate for Payer: Health Management Network Commercial |
$396.10
|
| Rate for Payer: Humana Medicare |
$233.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$419.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$237.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$233.00
|
| Rate for Payer: MDX Hawaii PPO |
$452.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$233.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$233.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$233.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
AFB Smear FSI
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 87150
|
| Hospital Charge Code |
8228832
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: AlohaCare Medicaid |
$182.50
|
| Rate for Payer: AlohaCare Medicare |
$182.50
|
| Rate for Payer: Cash Price |
$237.25
|
| Rate for Payer: Cash Price |
$237.25
|
| Rate for Payer: Devoted Health Medicare |
$200.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.27
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$182.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$310.25
|
| Rate for Payer: Humana Medicare |
$182.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$328.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$186.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$182.50
|
| Rate for Payer: MDX Hawaii PPO |
$354.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$182.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$182.50
|
| Rate for Payer: University Health Alliance Commercial |
$91.37
|
|
|
AFB Smear FSI
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 87150
|
| Hospital Charge Code |
8228832
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$310.25 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: Cash Price |
$237.25
|
| Rate for Payer: Health Management Network Commercial |
$310.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$328.50
|
| Rate for Payer: MDX Hawaii PPO |
$354.05
|
|
|
AFP4, Quad Screen FSI
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
8117767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$390.91 |
| Rate for Payer: AlohaCare Medicaid |
$201.50
|
| Rate for Payer: AlohaCare Medicare |
$201.50
|
| Rate for Payer: Cash Price |
$261.95
|
| Rate for Payer: Cash Price |
$261.95
|
| Rate for Payer: Devoted Health Medicare |
$221.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$201.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.77
|
| Rate for Payer: Health Management Network Commercial |
$342.55
|
| Rate for Payer: Humana Medicare |
$201.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$362.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$205.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$201.50
|
| Rate for Payer: MDX Hawaii PPO |
$390.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$201.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$201.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$201.50
|
| Rate for Payer: University Health Alliance Commercial |
$43.36
|
|
