|
Bill Only 87077 Ident, Aerobic Isol, 5
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 87077
|
| Hospital Charge Code |
13407404
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$100.88 |
| Rate for Payer: AlohaCare Medicaid |
$52.00
|
| Rate for Payer: AlohaCare Medicare |
$52.00
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Devoted Health Medicare |
$57.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$52.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.08
|
| Rate for Payer: Health Management Network Commercial |
$88.40
|
| Rate for Payer: Humana Medicare |
$52.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$53.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$52.00
|
| Rate for Payer: MDX Hawaii PPO |
$100.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$52.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$52.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$52.00
|
| Rate for Payer: University Health Alliance Commercial |
$20.89
|
|
|
Bill Only 87107 Ident, Mold Isolates, 1
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
13416122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicare |
$11.50
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Devoted Health Medicare |
$12.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$14.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Humana Medicare |
$11.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.50
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.50
|
| Rate for Payer: University Health Alliance Commercial |
$26.68
|
|
|
Bill Only 87107 Ident, Mold Isolates, 1
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS 87107
|
| Hospital Charge Code |
13416122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
|
|
Bill Only 87181 Disk Diffusion and 2 E-test
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
13416119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$35.50
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$39.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$35.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.50
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
Bill Only 87181 Disk Diffusion and 2 E-test
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
13416119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
Bill Only 87181 Disk Diffusion and E-test
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
13416120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: AlohaCare Medicaid |
$35.50
|
| Rate for Payer: AlohaCare Medicare |
$35.50
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Devoted Health Medicare |
$39.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Humana Medicare |
$35.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.50
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
Bill Only 87181 Disk Diffusion and E-test
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
13416120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$68.87 |
| Rate for Payer: Cash Price |
$46.15
|
| Rate for Payer: Health Management Network Commercial |
$60.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.90
|
| Rate for Payer: MDX Hawaii PPO |
$68.87
|
|
|
Bill Only 87186 Susceptibility,Aerobic Bacteria,MIC
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
13407416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
|
|
Bill Only 87186 Susceptibility,Aerobic Bacteria,MIC
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
13407416
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$147.44 |
| Rate for Payer: AlohaCare Medicaid |
$76.00
|
| Rate for Payer: AlohaCare Medicare |
$76.00
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Cash Price |
$98.80
|
| Rate for Payer: Devoted Health Medicare |
$83.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.65
|
| Rate for Payer: Health Management Network Commercial |
$129.20
|
| Rate for Payer: Humana Medicare |
$76.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.00
|
| Rate for Payer: MDX Hawaii PPO |
$147.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.00
|
| Rate for Payer: University Health Alliance Commercial |
$22.35
|
|
|
Bill Only 87206 Fungus Smear by Calcofluor White
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
13395383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
Bill Only 87206 Fungus Smear by Calcofluor White
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
13395383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$8.00
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Devoted Health Medicare |
$8.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.39
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$8.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.00
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.00
|
| Rate for Payer: University Health Alliance Commercial |
$13.88
|
|
|
Bill Only 87305 Aspergillus Ag
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
13407398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$225.04 |
| Rate for Payer: AlohaCare Medicaid |
$116.00
|
| Rate for Payer: AlohaCare Medicare |
$116.00
|
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Devoted Health Medicare |
$127.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$197.20
|
| Rate for Payer: Humana Medicare |
$116.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$118.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.00
|
| Rate for Payer: MDX Hawaii PPO |
$225.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only 87305 Aspergillus Ag
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
13407398
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$225.04 |
| Rate for Payer: Cash Price |
$150.80
|
| Rate for Payer: Health Management Network Commercial |
$197.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$208.80
|
| Rate for Payer: MDX Hawaii PPO |
$225.04
|
|
|
Bill Only 87449 Campylobacter Antigen
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
13407401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$67.90
|
|
|
Bill Only 87449 Campylobacter Antigen
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
13407401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$67.90 |
| Rate for Payer: AlohaCare Medicaid |
$35.00
|
| Rate for Payer: AlohaCare Medicare |
$35.00
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Cash Price |
$45.50
|
| Rate for Payer: Devoted Health Medicare |
$38.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$59.50
|
| Rate for Payer: Humana Medicare |
$35.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.00
|
| Rate for Payer: MDX Hawaii PPO |
$67.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only 87449 Fungitell, Serum
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
13395382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: AlohaCare Medicaid |
$77.00
|
| Rate for Payer: AlohaCare Medicare |
$77.00
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Devoted Health Medicare |
$84.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Humana Medicare |
$77.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.00
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only 87449 Fungitell, Serum
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
13395382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$149.38 |
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Health Management Network Commercial |
$130.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$138.60
|
| Rate for Payer: MDX Hawaii PPO |
$149.38
|
|
|
Bill Only 87502 Influenza A/B (Cepheid)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407405
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: AlohaCare Medicaid |
$152.50
|
| Rate for Payer: AlohaCare Medicare |
$152.50
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Devoted Health Medicare |
$167.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$152.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
| Rate for Payer: Humana Medicare |
$152.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$155.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$152.50
|
| Rate for Payer: MDX Hawaii PPO |
$295.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$152.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$152.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$152.50
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
Bill Only 87502 Influenza A/B (Cepheid)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407405
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$259.25 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Cash Price |
$198.25
|
| Rate for Payer: Health Management Network Commercial |
$259.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.50
|
| Rate for Payer: MDX Hawaii PPO |
$295.85
|
|
|
Bill Only 87502 Influenza A/B/RSV, Real-time PCR
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$434.56 |
| Rate for Payer: AlohaCare Medicaid |
$224.00
|
| Rate for Payer: AlohaCare Medicare |
$224.00
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Devoted Health Medicare |
$246.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$119.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$224.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$117.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.80
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Humana Medicare |
$224.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$228.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$224.00
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$224.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$224.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$119.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$224.00
|
| Rate for Payer: University Health Alliance Commercial |
$221.54
|
|
|
Bill Only 87502 Influenza A/B/RSV, Real-time PCR
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
HCPCS 87502
|
| Hospital Charge Code |
13407406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$434.56 |
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Health Management Network Commercial |
$380.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$403.20
|
| Rate for Payer: MDX Hawaii PPO |
$434.56
|
|
|
Bill Only 87624 PAP and HPV Co-Testing
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
13395390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
Bill Only 87624 PAP and HPV Co-Testing
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 87624
|
| Hospital Charge Code |
13395390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Devoted Health Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$88.36
|
|
|
Bill Only 87899 S. pneumoniae Antigen w/ CSF Culture & Gram Stain
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
13407410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: AlohaCare Medicaid |
$58.00
|
| Rate for Payer: AlohaCare Medicare |
$58.00
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Devoted Health Medicare |
$63.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.07
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Humana Medicare |
$58.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.00
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only 87899 S. pneumoniae Antigen w/ CSF Culture & Gram Stain
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 87899
|
| Hospital Charge Code |
13407410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$112.52 |
| Rate for Payer: Cash Price |
$75.40
|
| Rate for Payer: Health Management Network Commercial |
$98.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$104.40
|
| Rate for Payer: MDX Hawaii PPO |
$112.52
|
|
