|
Blood Draw from Arterial Line
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
11112761
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.75 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
|
|
Blood Draw from Arterial Line
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
11112761
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$801.11 |
| Rate for Payer: AlohaCare Medicaid |
$127.50
|
| Rate for Payer: AlohaCare Medicare |
$127.50
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Cash Price |
$165.75
|
| Rate for Payer: Devoted Health Medicare |
$140.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.25
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Humana Medicare |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.50
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.50
|
| Rate for Payer: University Health Alliance Commercial |
$142.80
|
|
|
Blood Draw from Central Line
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
11106988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$320.10 |
| Rate for Payer: AlohaCare Medicaid |
$165.00
|
| Rate for Payer: AlohaCare Medicare |
$165.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Devoted Health Medicare |
$181.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.50
|
| Rate for Payer: Health Management Network Commercial |
$280.50
|
| Rate for Payer: Humana Medicare |
$165.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$168.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.00
|
| Rate for Payer: MDX Hawaii PPO |
$320.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.00
|
| Rate for Payer: University Health Alliance Commercial |
$184.80
|
|
|
Blood Draw from Central Line
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
11106988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$320.10 |
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Health Management Network Commercial |
$280.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.00
|
| Rate for Payer: MDX Hawaii PPO |
$320.10
|
|
|
Blood Draw From CENTRAL LINE or PICC Charge
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8386872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$413.95 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
|
|
Blood Draw From CENTRAL LINE or PICC Charge
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 36591
|
| Hospital Charge Code |
8386872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$472.39 |
| Rate for Payer: AlohaCare Medicaid |
$243.50
|
| Rate for Payer: AlohaCare Medicare |
$243.50
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Cash Price |
$316.55
|
| Rate for Payer: Devoted Health Medicare |
$267.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$243.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$462.65
|
| Rate for Payer: Health Management Network Commercial |
$413.95
|
| Rate for Payer: Humana Medicare |
$243.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$438.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$248.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$243.50
|
| Rate for Payer: MDX Hawaii PPO |
$472.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$243.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$243.50
|
| Rate for Payer: University Health Alliance Commercial |
$272.72
|
|
|
Blood Draw or Accessing Implantable Port
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
11112762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$280.50 |
| Max. Negotiated Rate |
$320.10 |
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Health Management Network Commercial |
$280.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.00
|
| Rate for Payer: MDX Hawaii PPO |
$320.10
|
|
|
Blood Draw or Accessing Implantable Port
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 36592
|
| Hospital Charge Code |
11112762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$320.10 |
| Rate for Payer: AlohaCare Medicaid |
$165.00
|
| Rate for Payer: AlohaCare Medicare |
$165.00
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Devoted Health Medicare |
$181.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$313.50
|
| Rate for Payer: Health Management Network Commercial |
$280.50
|
| Rate for Payer: Humana Medicare |
$165.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$297.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$168.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.00
|
| Rate for Payer: MDX Hawaii PPO |
$320.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.00
|
| Rate for Payer: University Health Alliance Commercial |
$184.80
|
|
|
Blood Gas Arterial Cord FSI
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$289.85 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
|
|
Blood Gas Arterial Cord FSI
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: AlohaCare Medicaid |
$170.50
|
| Rate for Payer: AlohaCare Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$187.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Humana Medicare |
$170.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.50
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
Blood Gas Arterial FSI
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8128108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$289.85 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
|
|
Blood Gas Arterial FSI
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8128108
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: AlohaCare Medicaid |
$170.50
|
| Rate for Payer: AlohaCare Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$187.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Humana Medicare |
$170.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.50
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
Blood Gas Capillary FSI
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$289.85 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
|
|
Blood Gas Capillary FSI
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: AlohaCare Medicaid |
$170.50
|
| Rate for Payer: AlohaCare Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$187.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Humana Medicare |
$170.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.50
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
BLOOD GAS DRAW CHARGE
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
8243035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| 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 |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$129.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| 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 |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$129.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
BLOOD GAS DRAW CHARGE
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
8243035
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
Blood Gases Arterial POCT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
9364577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.60
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
|
|
Blood Gases Arterial POCT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
9364577
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: AlohaCare Medicaid |
$132.00
|
| Rate for Payer: AlohaCare Medicare |
$132.00
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Devoted Health Medicare |
$145.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Humana Medicare |
$132.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.00
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
Blood Gases Venous POCT
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
9364578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.60
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
|
|
Blood Gases Venous POCT
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
9364578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$256.08 |
| Rate for Payer: AlohaCare Medicaid |
$132.00
|
| Rate for Payer: AlohaCare Medicare |
$132.00
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Devoted Health Medicare |
$145.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$224.40
|
| Rate for Payer: Humana Medicare |
$132.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$134.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.00
|
| Rate for Payer: MDX Hawaii PPO |
$256.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.00
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
Blood Gas FSI
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8290701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$289.85 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
|
|
Blood Gas FSI
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8290701
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: AlohaCare Medicaid |
$170.50
|
| Rate for Payer: AlohaCare Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$187.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Humana Medicare |
$170.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.50
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
Blood Gas Venous Cord FSI
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: AlohaCare Medicaid |
$170.50
|
| Rate for Payer: AlohaCare Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$187.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Humana Medicare |
$170.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.50
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
|
Blood Gas Venous Cord FSI
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$289.85 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
|
|
Blood Gas Venous FSI
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
HCPCS 82805
|
| Hospital Charge Code |
8395711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$330.77 |
| Rate for Payer: AlohaCare Medicaid |
$170.50
|
| Rate for Payer: AlohaCare Medicare |
$170.50
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Cash Price |
$221.65
|
| Rate for Payer: Devoted Health Medicare |
$187.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$39.21
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$98.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$41.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$78.77
|
| Rate for Payer: Health Management Network Commercial |
$289.85
|
| Rate for Payer: Humana Medicare |
$170.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.50
|
| Rate for Payer: MDX Hawaii PPO |
$330.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.35
|
|
