|
Bill Only AP 88342 IHC EA Ab
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
HCPCS 88342 TC
|
| Hospital Charge Code |
8196804
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$420.98 |
| Rate for Payer: AlohaCare Medicaid |
$217.00
|
| Rate for Payer: AlohaCare Medicare |
$217.00
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Devoted Health Medicare |
$238.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$28.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$217.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.30
|
| Rate for Payer: Health Management Network Commercial |
$368.90
|
| Rate for Payer: Humana Medicare |
$217.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$390.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$217.00
|
| Rate for Payer: MDX Hawaii PPO |
$420.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$217.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$217.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$217.00
|
| Rate for Payer: University Health Alliance Commercial |
$115.59
|
|
|
Bill Only AP 88358 Morph Analysis Tumor
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
HCPCS 88358 TC
|
| Hospital Charge Code |
8196796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$634.10 |
| Max. Negotiated Rate |
$723.62 |
| Rate for Payer: Cash Price |
$484.90
|
| Rate for Payer: Health Management Network Commercial |
$634.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$671.40
|
| Rate for Payer: MDX Hawaii PPO |
$723.62
|
|
|
Bill Only AP 88358 Morph Analysis Tumor
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
HCPCS 88358 TC
|
| Hospital Charge Code |
8196796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$723.62 |
| Rate for Payer: AlohaCare Medicaid |
$373.00
|
| Rate for Payer: AlohaCare Medicare |
$373.00
|
| Rate for Payer: Cash Price |
$484.90
|
| Rate for Payer: Cash Price |
$484.90
|
| Rate for Payer: Devoted Health Medicare |
$410.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$373.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$43.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$708.70
|
| Rate for Payer: Health Management Network Commercial |
$634.10
|
| Rate for Payer: Humana Medicare |
$373.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$671.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$380.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$373.00
|
| Rate for Payer: MDX Hawaii PPO |
$723.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$373.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$373.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$373.00
|
| Rate for Payer: University Health Alliance Commercial |
$58.87
|
|
|
Bill Only AP 88361 Tumor Comp Analysis
|
Facility
|
OP
|
$931.00
|
|
|
Service Code
|
HCPCS 88361 TC
|
| Hospital Charge Code |
8080876
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.41 |
| Max. Negotiated Rate |
$903.07 |
| Rate for Payer: AlohaCare Medicaid |
$465.50
|
| Rate for Payer: AlohaCare Medicare |
$465.50
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Devoted Health Medicare |
$512.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$67.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$465.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$83.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$884.45
|
| Rate for Payer: Health Management Network Commercial |
$791.35
|
| Rate for Payer: Humana Medicare |
$465.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$837.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$474.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$465.50
|
| Rate for Payer: MDX Hawaii PPO |
$903.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$465.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$465.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$465.50
|
| Rate for Payer: University Health Alliance Commercial |
$206.28
|
|
|
Bill Only AP 88361 Tumor Comp Analysis
|
Facility
|
IP
|
$931.00
|
|
|
Service Code
|
HCPCS 88361 TC
|
| Hospital Charge Code |
8080876
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$791.35 |
| Max. Negotiated Rate |
$903.07 |
| Rate for Payer: Cash Price |
$605.15
|
| Rate for Payer: Health Management Network Commercial |
$791.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$837.90
|
| Rate for Payer: MDX Hawaii PPO |
$903.07
|
|
|
Bill Only AP 88365 Insitu Hybrid Tech
|
Facility
|
IP
|
$672.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
8080867
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$651.84 |
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$604.80
|
| Rate for Payer: MDX Hawaii PPO |
$651.84
|
|
|
Bill Only AP 88365 Insitu Hybrid Tech
|
Facility
|
OP
|
$672.00
|
|
|
Service Code
|
HCPCS 88365 TC
|
| Hospital Charge Code |
8080867
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$651.84 |
| Rate for Payer: AlohaCare Medicaid |
$336.00
|
| Rate for Payer: AlohaCare Medicare |
$336.00
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Devoted Health Medicare |
$369.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$336.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$638.40
|
| Rate for Payer: Health Management Network Commercial |
$571.20
|
| Rate for Payer: Humana Medicare |
$336.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$604.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$342.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$336.00
|
| Rate for Payer: MDX Hawaii PPO |
$651.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$336.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$336.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$336.00
|
| Rate for Payer: University Health Alliance Commercial |
$187.68
|
|
|
Bill Only AP 88368 ANA In Situ Hybrid EA
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 88368 TC
|
| Hospital Charge Code |
8196805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
Bill Only AP 88368 ANA In Situ Hybrid EA
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 88368 TC
|
| Hospital Charge Code |
8196805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$92.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$264.24
|
|
|
Bill Only ASPAG (Asper Galactomannan Ag) FSI
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
8453173
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$76.45
|
| 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 |
$69.50
|
| 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 |
$118.15
|
| Rate for Payer: Humana Medicare |
$69.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.50
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Bill Only ASPAG (Asper Galactomannan Ag) FSI
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
8453173
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
Bill Only Bill For Full Crossmatch
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
8301491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$280.33 |
| Rate for Payer: AlohaCare Medicaid |
$144.50
|
| Rate for Payer: AlohaCare Medicare |
$144.50
|
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Devoted Health Medicare |
$158.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Humana Medicare |
$144.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.50
|
| Rate for Payer: MDX Hawaii PPO |
$280.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.50
|
| Rate for Payer: University Health Alliance Commercial |
$161.84
|
|
|
Bill Only Bill For Full Crossmatch
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS 86922
|
| Hospital Charge Code |
8301491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$245.65 |
| Max. Negotiated Rate |
$280.33 |
| Rate for Payer: Cash Price |
$187.85
|
| Rate for Payer: Health Management Network Commercial |
$245.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.10
|
| Rate for Payer: MDX Hawaii PPO |
$280.33
|
|
|
Bill Only Blood Glucose for 2 Hr GTT
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
12925325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: AlohaCare Medicaid |
$47.00
|
| Rate for Payer: AlohaCare Medicare |
$47.00
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Devoted Health Medicare |
$51.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.30
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Humana Medicare |
$47.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.00
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.00
|
| Rate for Payer: University Health Alliance Commercial |
$52.64
|
|
|
Bill Only Blood Glucose for 2 Hr GTT
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
12925325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$91.18 |
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.60
|
| Rate for Payer: MDX Hawaii PPO |
$91.18
|
|
|
Bill Only Capillary Draw Charge
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
8301484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$6.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.00
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.00
|
| Rate for Payer: University Health Alliance Commercial |
$6.72
|
|
|
Bill Only Capillary Draw Charge
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS 36416
|
| Hospital Charge Code |
8301484
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
|
|
Bill Only Chloride, 24 Hr Urine
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
12925321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: AlohaCare Medicaid |
$25.50
|
| Rate for Payer: AlohaCare Medicare |
$25.50
|
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: Devoted Health Medicare |
$28.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Humana Medicare |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.50
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.50
|
| Rate for Payer: University Health Alliance Commercial |
$12.99
|
|
|
Bill Only Chloride, 24 Hr Urine
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 82436
|
| Hospital Charge Code |
12925321
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.35 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: Cash Price |
$33.15
|
| Rate for Payer: Health Management Network Commercial |
$43.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.90
|
| Rate for Payer: MDX Hawaii PPO |
$49.47
|
|
|
Bill Only Clindamycin Induct Fee
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301482
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$20.50
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$22.55
|
| 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 |
$20.50
|
| 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 |
$34.85
|
| Rate for Payer: Humana Medicare |
$20.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.50
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
Bill Only Clindamycin Induct Fee
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301482
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
Bill Only Clindamycin Induct X2
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
Bill Only Clindamycin Induct X2
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
8301483
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$20.50
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$22.55
|
| 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 |
$20.50
|
| 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 |
$34.85
|
| Rate for Payer: Humana Medicare |
$20.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.50
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$4.81
|
|
|
Bill only - Clonazepam
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
12517667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$339.50 |
| Rate for Payer: AlohaCare Medicaid |
$175.00
|
| Rate for Payer: AlohaCare Medicare |
$175.00
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Devoted Health Medicare |
$192.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Humana Medicare |
$175.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$178.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.00
|
| Rate for Payer: MDX Hawaii PPO |
$339.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.00
|
| Rate for Payer: University Health Alliance Commercial |
$35.39
|
|
|
Bill only - Clonazepam
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
12517667
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$339.50 |
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Health Management Network Commercial |
$297.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.00
|
| Rate for Payer: MDX Hawaii PPO |
$339.50
|
|
