|
Bill Only 83986 pH, Stool
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
13407409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$18.50
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Devoted Health Medicare |
$20.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.58
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.50
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.25
|
|
|
Bill Only 83986 pH, Stool
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 83986
|
| Hospital Charge Code |
13407409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$24.05
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
Bill Only 83993 Calprotectin, Feces
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 83993
|
| Hospital Charge Code |
13416116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$251.23 |
| Rate for Payer: AlohaCare Medicaid |
$129.50
|
| Rate for Payer: AlohaCare Medicare |
$129.50
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Devoted Health Medicare |
$142.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.63
|
| Rate for Payer: Health Management Network Commercial |
$220.15
|
| Rate for Payer: Humana Medicare |
$129.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$129.50
|
| Rate for Payer: MDX Hawaii PPO |
$251.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$129.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$129.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.73
|
|
|
Bill Only 83993 Calprotectin, Feces
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 83993
|
| Hospital Charge Code |
13416116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.15 |
| Max. Negotiated Rate |
$251.23 |
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Health Management Network Commercial |
$220.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$233.10
|
| Rate for Payer: MDX Hawaii PPO |
$251.23
|
|
|
Bill Only 86022 Serotonin Release Assay, LMWH
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
13395391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$269.45 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.30
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
|
|
Bill Only 86022 Serotonin Release Assay, LMWH
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS 86022
|
| Hospital Charge Code |
13395391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$307.49 |
| Rate for Payer: AlohaCare Medicaid |
$158.50
|
| Rate for Payer: AlohaCare Medicare |
$158.50
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Cash Price |
$206.05
|
| Rate for Payer: Devoted Health Medicare |
$174.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.37
|
| Rate for Payer: Health Management Network Commercial |
$269.45
|
| Rate for Payer: Humana Medicare |
$158.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$285.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$161.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.50
|
| Rate for Payer: MDX Hawaii PPO |
$307.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$158.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.50
|
| Rate for Payer: University Health Alliance Commercial |
$47.47
|
|
|
Bill Only 86036 ANCA Vasculitides
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
13395377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$255.85 |
| Max. Negotiated Rate |
$291.97 |
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.90
|
| Rate for Payer: MDX Hawaii PPO |
$291.97
|
|
|
Bill Only 86036 ANCA Vasculitides
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
HCPCS 86036
|
| Hospital Charge Code |
13395377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$291.97 |
| Rate for Payer: AlohaCare Medicaid |
$150.50
|
| Rate for Payer: AlohaCare Medicare |
$150.50
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Cash Price |
$195.65
|
| Rate for Payer: Devoted Health Medicare |
$165.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$255.85
|
| Rate for Payer: Humana Medicare |
$150.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$270.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.50
|
| Rate for Payer: MDX Hawaii PPO |
$291.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.50
|
| Rate for Payer: University Health Alliance Commercial |
$168.56
|
|
|
Bill Only 86037 C-ANCA Titer
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
13395379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: AlohaCare Medicaid |
$65.00
|
| Rate for Payer: AlohaCare Medicare |
$65.00
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Devoted Health Medicare |
$71.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Humana Medicare |
$65.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.00
|
| Rate for Payer: MDX Hawaii PPO |
$126.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.00
|
| Rate for Payer: University Health Alliance Commercial |
$72.80
|
|
|
Bill Only 86037 C-ANCA Titer
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
13395379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Health Management Network Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.00
|
| Rate for Payer: MDX Hawaii PPO |
$126.10
|
|
|
Bill Only 86316 Chromogranin A
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
13416117
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Bill Only 86316 Chromogranin A
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
13416117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| 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 |
$28.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.81
|
| 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 |
$28.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.50
|
| Rate for Payer: University Health Alliance Commercial |
$53.78
|
|
|
Bill Only 86359 CD4 T-Cell Count
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
13395380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: AlohaCare Medicaid |
$72.00
|
| Rate for Payer: AlohaCare Medicare |
$72.00
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$79.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.13
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.73
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Humana Medicare |
$72.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.00
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.00
|
| Rate for Payer: University Health Alliance Commercial |
$97.50
|
|
|
Bill Only 86359 CD4 T-Cell Count
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
13395380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$139.68 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$129.60
|
| Rate for Payer: MDX Hawaii PPO |
$139.68
|
|
|
Bill Only 86381 Mitochondrial M2 Antibody
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
13395389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.27 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$54.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Devoted Health Medicare |
$59.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$31.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.45
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$54.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.00
|
| Rate for Payer: University Health Alliance Commercial |
$60.48
|
|
|
Bill Only 86381 Mitochondrial M2 Antibody
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 86381
|
| Hospital Charge Code |
13395389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
Bill Only 86593 RPR Titer
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
13416125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
Bill Only 86593 RPR Titer
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 86593
|
| Hospital Charge Code |
13416125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$10.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Devoted Health Medicare |
$11.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.09
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.40
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.00
|
| Rate for Payer: University Health Alliance Commercial |
$11.40
|
|
|
Bill Only 86870 Antibody Identification
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
13407397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$457.76 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicare |
$45.50
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Devoted Health Medicare |
$50.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$55.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$457.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$30.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.21
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Humana Medicare |
$45.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.50
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.96
|
|
|
Bill Only 86870 Antibody Identification
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS 86870
|
| Hospital Charge Code |
13407397
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.35 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
Bill Only 87045 Stool Culture
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
13395392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: AlohaCare Medicaid |
$62.50
|
| Rate for Payer: AlohaCare Medicare |
$62.50
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Devoted Health Medicare |
$68.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Humana Medicare |
$62.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.50
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
Bill Only 87045 Stool Culture
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
13395392
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$121.25 |
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$121.25
|
|
|
Bill Only 87045 Stool Culture, Campy Antigen, and Shiga Toxin
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
13407411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: AlohaCare Medicaid |
$119.00
|
| Rate for Payer: AlohaCare Medicare |
$119.00
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Devoted Health Medicare |
$130.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$13.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Humana Medicare |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$121.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.00
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.00
|
| Rate for Payer: University Health Alliance Commercial |
$24.38
|
|
|
Bill Only 87045 Stool Culture, Campy Antigen, and Shiga Toxin
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
13407411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.30 |
| Max. Negotiated Rate |
$230.86 |
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Health Management Network Commercial |
$202.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$214.20
|
| Rate for Payer: MDX Hawaii PPO |
$230.86
|
|
|
Bill Only 87077 Ident, Aerobic Isol, 5
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
13407404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
|
