|
LOW PROFILE SCREW, 2.4MM X 38MM CORTEX
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: AlohaCare Medicaid |
$72.50
|
| Rate for Payer: AlohaCare Medicare |
$72.50
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$79.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$72.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Humana Medicare |
$72.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$73.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$72.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$72.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$72.50
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LOW PROFILE SCREW, 2.4MM X 38MM CORTEX
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
12989537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$101.50
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$130.50
|
| Rate for Payer: MDX Hawaii PPO |
$140.65
|
| Rate for Payer: University Health Alliance Commercial |
$81.20
|
|
|
LTD Color Doppler
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 93325
|
| Hospital Charge Code |
12216457
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$495.67 |
| Rate for Payer: AlohaCare Medicaid |
$255.50
|
| Rate for Payer: AlohaCare Medicare |
$255.50
|
| Rate for Payer: Cash Price |
$332.15
|
| Rate for Payer: Cash Price |
$332.15
|
| Rate for Payer: Devoted Health Medicare |
$281.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$96.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$40.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$485.45
|
| Rate for Payer: Health Management Network Commercial |
$434.35
|
| Rate for Payer: Humana Medicare |
$255.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.50
|
| Rate for Payer: MDX Hawaii PPO |
$495.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$255.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$96.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.50
|
| Rate for Payer: University Health Alliance Commercial |
$286.16
|
|
|
LTD Color Doppler
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 93325
|
| Hospital Charge Code |
12216457
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$434.35 |
| Max. Negotiated Rate |
$495.67 |
| Rate for Payer: Cash Price |
$332.15
|
| Rate for Payer: Health Management Network Commercial |
$434.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$459.90
|
| Rate for Payer: MDX Hawaii PPO |
$495.67
|
|
|
LTD Spectral Doppler
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
12205326
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$373.15 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Cash Price |
$285.35
|
| Rate for Payer: Health Management Network Commercial |
$373.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$395.10
|
| Rate for Payer: MDX Hawaii PPO |
$425.83
|
|
|
LTD Spectral Doppler
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
12205326
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: AlohaCare Medicaid |
$219.50
|
| Rate for Payer: AlohaCare Medicare |
$219.50
|
| Rate for Payer: Cash Price |
$285.35
|
| Rate for Payer: Cash Price |
$285.35
|
| Rate for Payer: Devoted Health Medicare |
$241.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$219.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$417.05
|
| Rate for Payer: Health Management Network Commercial |
$373.15
|
| Rate for Payer: Humana Medicare |
$219.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$395.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.50
|
| Rate for Payer: MDX Hawaii PPO |
$425.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$219.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$219.50
|
| Rate for Payer: University Health Alliance Commercial |
$245.84
|
|
|
lumateperone 42 mg capsule [HHSC]
|
Facility
|
OP
|
$306.69
|
|
|
Service Code
|
NDC 72060014240
|
| Hospital Charge Code |
2501090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$153.34 |
| Max. Negotiated Rate |
$297.49 |
| Rate for Payer: AlohaCare Medicaid |
$153.34
|
| Rate for Payer: AlohaCare Medicare |
$153.34
|
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Devoted Health Medicare |
$168.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.36
|
| Rate for Payer: Health Management Network Commercial |
$260.69
|
| Rate for Payer: Humana Medicare |
$153.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$156.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.34
|
| Rate for Payer: MDX Hawaii PPO |
$297.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$184.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.34
|
| Rate for Payer: University Health Alliance Commercial |
$223.55
|
|
|
lumateperone 42 mg capsule [HHSC]
|
Facility
|
IP
|
$306.69
|
|
|
Service Code
|
NDC 72060014240
|
| Hospital Charge Code |
2501090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$260.69 |
| Max. Negotiated Rate |
$297.49 |
| Rate for Payer: Cash Price |
$199.35
|
| Rate for Payer: Health Management Network Commercial |
$260.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$276.02
|
| Rate for Payer: MDX Hawaii PPO |
$297.49
|
|
|
Lumbar Tray at Bedside
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
1909307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$965.60 |
| Max. Negotiated Rate |
$1,101.92 |
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Health Management Network Commercial |
$965.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,101.92
|
|
|
Lumbar Tray at Bedside
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 62270
|
| Hospital Charge Code |
1909307
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$568.00
|
| Rate for Payer: AlohaCare Medicare |
$568.00
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Devoted Health Medicare |
$624.80
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$901.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$568.00
|
| Rate for Payer: Health Management Network Commercial |
$965.60
|
| Rate for Payer: Humana Medicare |
$568.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,022.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,101.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$568.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$568.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$568.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
LUNG TRANSPLANT
|
Facility
|
IP
|
$10,400.00
|
|
|
Service Code
|
MSDRG 007
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$10,400.00 |
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
lurasidone 20 mg tablet [HHSC]
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
NDC 60687074721
|
| Hospital Charge Code |
2501113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: AlohaCare Medicaid |
$14.21
|
| Rate for Payer: AlohaCare Medicare |
$14.21
|
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Devoted Health Medicare |
$15.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.99
|
| Rate for Payer: Health Management Network Commercial |
$24.15
|
| Rate for Payer: Humana Medicare |
$14.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.21
|
| Rate for Payer: MDX Hawaii PPO |
$27.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.21
|
| Rate for Payer: University Health Alliance Commercial |
$20.71
|
|
|
lurasidone 20 mg tablet [HHSC]
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
NDC 60687074721
|
| Hospital Charge Code |
2501113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$27.56 |
| Rate for Payer: Cash Price |
$18.47
|
| Rate for Payer: Health Management Network Commercial |
$24.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.57
|
| Rate for Payer: MDX Hawaii PPO |
$27.56
|
|
|
lurasidone 80 mg tablet [HHSC]
|
Facility
|
IP
|
$222.70
|
|
|
Service Code
|
NDC 63402030830
|
| Hospital Charge Code |
2500505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.29 |
| Max. Negotiated Rate |
$216.02 |
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Health Management Network Commercial |
$189.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.43
|
| Rate for Payer: MDX Hawaii PPO |
$216.02
|
|
|
lurasidone 80 mg tablet [HHSC]
|
Facility
|
IP
|
$29.36
|
|
|
Service Code
|
NDC 60687078021
|
| Hospital Charge Code |
2500505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Cash Price |
$19.08
|
| Rate for Payer: Health Management Network Commercial |
$24.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.42
|
| Rate for Payer: MDX Hawaii PPO |
$28.48
|
|
|
lurasidone 80 mg tablet [HHSC]
|
Facility
|
OP
|
$29.36
|
|
|
Service Code
|
NDC 60687078021
|
| Hospital Charge Code |
2500505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: AlohaCare Medicaid |
$14.68
|
| Rate for Payer: AlohaCare Medicare |
$14.68
|
| Rate for Payer: Cash Price |
$19.08
|
| Rate for Payer: Devoted Health Medicare |
$16.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.89
|
| Rate for Payer: Health Management Network Commercial |
$24.96
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.68
|
| Rate for Payer: MDX Hawaii PPO |
$28.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.68
|
| Rate for Payer: University Health Alliance Commercial |
$21.40
|
|
|
lurasidone 80 mg tablet [HHSC]
|
Facility
|
OP
|
$222.70
|
|
|
Service Code
|
NDC 63402030830
|
| Hospital Charge Code |
2500505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$216.02 |
| Rate for Payer: AlohaCare Medicaid |
$111.35
|
| Rate for Payer: AlohaCare Medicare |
$111.35
|
| Rate for Payer: Cash Price |
$144.76
|
| Rate for Payer: Devoted Health Medicare |
$122.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$111.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$211.56
|
| Rate for Payer: Health Management Network Commercial |
$189.29
|
| Rate for Payer: Humana Medicare |
$111.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$200.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$113.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.35
|
| Rate for Payer: MDX Hawaii PPO |
$216.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$111.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$111.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$111.35
|
| Rate for Payer: University Health Alliance Commercial |
$162.33
|
|
|
lurasidone 80 mg tablet [HHSC]
|
Facility
|
IP
|
$176.29
|
|
|
Service Code
|
NDC 62332049730
|
| Hospital Charge Code |
2500505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$149.85 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Cash Price |
$114.59
|
| Rate for Payer: Health Management Network Commercial |
$149.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.66
|
| Rate for Payer: MDX Hawaii PPO |
$171.00
|
|
|
lurasidone 80 mg tablet [HHSC]
|
Facility
|
OP
|
$176.29
|
|
|
Service Code
|
NDC 62332049730
|
| Hospital Charge Code |
2500505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.14 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: AlohaCare Medicaid |
$88.14
|
| Rate for Payer: AlohaCare Medicare |
$88.14
|
| Rate for Payer: Cash Price |
$114.59
|
| Rate for Payer: Devoted Health Medicare |
$96.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$88.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$167.48
|
| Rate for Payer: Health Management Network Commercial |
$149.85
|
| Rate for Payer: Humana Medicare |
$88.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$158.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$88.14
|
| Rate for Payer: MDX Hawaii PPO |
$171.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$88.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$88.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$88.14
|
| Rate for Payer: University Health Alliance Commercial |
$128.50
|
|
|
Luteinizing Hormone (LH) FSI
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 83002
|
| Hospital Charge Code |
8117986
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
Luteinizing Hormone (LH) FSI
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 83002
|
| Hospital Charge Code |
8117986
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$106.00
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$116.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$25.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.52
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$106.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.00
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.00
|
| Rate for Payer: University Health Alliance Commercial |
$47.88
|
|
|
Lyme AB Total Rfx IgG, IgM IB FSI
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
11240929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$121.50
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Devoted Health Medicare |
$133.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.03
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$121.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.50
|
| Rate for Payer: University Health Alliance Commercial |
$44.03
|
|
|
Lyme AB Total Rfx IgG, IgM IB FSI
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
11240929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
Lyme Disease Antibody , Rfx Immunoglot FSI
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
10383593
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$206.55 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
|
|
Lyme Disease Antibody , Rfx Immunoglot FSI
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
10383593
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$235.71 |
| Rate for Payer: AlohaCare Medicaid |
$121.50
|
| Rate for Payer: AlohaCare Medicare |
$121.50
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Devoted Health Medicare |
$133.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$23.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$24.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.03
|
| Rate for Payer: Health Management Network Commercial |
$206.55
|
| Rate for Payer: Humana Medicare |
$121.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$218.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$123.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.50
|
| Rate for Payer: MDX Hawaii PPO |
$235.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$121.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.50
|
| Rate for Payer: University Health Alliance Commercial |
$44.03
|
|
