|
Urinalysis Microscopic FSI
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
8404426
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$21.50
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Cash Price |
$27.95
|
| Rate for Payer: Devoted Health Medicare |
$23.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$36.55
|
| Rate for Payer: Humana Medicare |
$21.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.50
|
| Rate for Payer: MDX Hawaii PPO |
$41.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.50
|
| Rate for Payer: University Health Alliance Commercial |
$7.84
|
|
|
Urinary Catheter Insertion
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
617589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: Cash Price |
$284.70
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
|
|
Urinary Catheter Insertion
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
617589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$424.86 |
| Rate for Payer: AlohaCare Medicaid |
$219.00
|
| Rate for Payer: AlohaCare Medicare |
$219.00
|
| Rate for Payer: Cash Price |
$284.70
|
| Rate for Payer: Cash Price |
$284.70
|
| Rate for Payer: Devoted Health Medicare |
$240.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$219.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$416.10
|
| Rate for Payer: Health Management Network Commercial |
$372.30
|
| Rate for Payer: Humana Medicare |
$219.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.00
|
| Rate for Payer: MDX Hawaii PPO |
$424.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$219.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$219.00
|
| Rate for Payer: University Health Alliance Commercial |
$245.28
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$12,538.36
|
|
|
Service Code
|
MSDRG 693
|
| Min. Negotiated Rate |
$12,538.36 |
| Max. Negotiated Rate |
$12,538.36 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,538.36
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$11,708.79
|
|
|
Service Code
|
MSDRG 694
|
| Min. Negotiated Rate |
$11,708.79 |
| Max. Negotiated Rate |
$11,708.79 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$11,708.79
|
|
|
.Urine Cocaine Confirmation FSI
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
8728212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
|
|
.Urine Cocaine Confirmation FSI
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
HCPCS 80353
|
| Hospital Charge Code |
8728212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$224.07 |
| Rate for Payer: AlohaCare Medicaid |
$115.50
|
| Rate for Payer: AlohaCare Medicare |
$115.50
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Cash Price |
$150.15
|
| Rate for Payer: Devoted Health Medicare |
$127.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$115.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$219.45
|
| Rate for Payer: Health Management Network Commercial |
$196.35
|
| Rate for Payer: Humana Medicare |
$115.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$117.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.50
|
| Rate for Payer: MDX Hawaii PPO |
$224.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$115.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$115.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$115.50
|
| Rate for Payer: University Health Alliance Commercial |
$129.36
|
|
|
Urine Culture FSI
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
8118075
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Devoted Health Medicare |
$55.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.07
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Humana Medicare |
$50.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.00
|
| Rate for Payer: University Health Alliance Commercial |
$20.87
|
|
|
Urine Culture FSI
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
8118075
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
Urine Dipstick and Microscopy POC
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 81000
|
| Hospital Charge Code |
7678540
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$4.37
|
| Rate for Payer: AlohaCare Medicare |
$4.02
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
|
|
Urine Dipstick POC
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
607611
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
|
|
Urine Dipstick POC
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
607611
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$33.95 |
| Rate for Payer: AlohaCare Medicaid |
$17.50
|
| Rate for Payer: AlohaCare Medicare |
$17.50
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$19.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Humana Medicare |
$17.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$31.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.50
|
| Rate for Payer: MDX Hawaii PPO |
$33.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.50
|
| Rate for Payer: University Health Alliance Commercial |
$6.60
|
|
|
Urine Dipstick POC
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
8043029
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: AlohaCare Medicaid |
$3.54
|
| Rate for Payer: AlohaCare Medicare |
$3.48
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.55
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.48
|
|
|
Urine Dipstick POC
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
607611
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: AlohaCare Medicaid |
$3.54
|
| Rate for Payer: AlohaCare Medicare |
$3.48
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Devoted Health Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.55
|
| Rate for Payer: Health Management Network Commercial |
$29.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.48
|
|
|
Urine Dipstick POCT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
9841869
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: AlohaCare Medicaid |
$12.50
|
| Rate for Payer: AlohaCare Medicare |
$12.50
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Devoted Health Medicare |
$13.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Humana Medicare |
$12.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.50
|
| Rate for Payer: MDX Hawaii PPO |
$24.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.50
|
| Rate for Payer: University Health Alliance Commercial |
$6.60
|
|
|
Urine Dipstick POCT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
9841869
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Health Management Network Commercial |
$21.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.50
|
| Rate for Payer: MDX Hawaii PPO |
$24.25
|
|
|
Urine Drug Abuse Screen
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 80305 QW
|
| Hospital Charge Code |
12514270
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
|
Urine Drug Abuse Screen
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 80305 QW
|
| Hospital Charge Code |
12514270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| 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 |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| 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 |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.00
|
| Rate for Payer: University Health Alliance Commercial |
$27.68
|
|
|
Urine Drug Abuse Screen FSI
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
8228936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$1,342.48 |
| Rate for Payer: AlohaCare Medicaid |
$692.00
|
| Rate for Payer: AlohaCare Medicare |
$692.00
|
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Devoted Health Medicare |
$761.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$1,176.40
|
| Rate for Payer: Humana Medicare |
$692.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,245.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$705.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$692.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,342.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$692.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.00
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
Urine Drug Abuse Screen FSI
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
8228936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,176.40 |
| Max. Negotiated Rate |
$1,342.48 |
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Health Management Network Commercial |
$1,176.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,245.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,342.48
|
|
|
Urine Drug Screen FSI
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 80305 QW
|
| Hospital Charge Code |
8128158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
|
|
Urine Drug Screen FSI
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 80305 QW
|
| Hospital Charge Code |
8128158
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$148.41 |
| Rate for Payer: AlohaCare Medicaid |
$76.50
|
| Rate for Payer: AlohaCare Medicare |
$76.50
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Devoted Health Medicare |
$84.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$76.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$130.05
|
| Rate for Payer: Humana Medicare |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$137.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$78.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$148.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$76.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$76.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$76.50
|
| Rate for Payer: University Health Alliance Commercial |
$27.68
|
|
|
Urine Oxycodone Scrn FSI
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
8404560
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$1,342.48 |
| Rate for Payer: AlohaCare Medicaid |
$692.00
|
| Rate for Payer: AlohaCare Medicare |
$692.00
|
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Devoted Health Medicare |
$761.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$1,176.40
|
| Rate for Payer: Humana Medicare |
$692.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,245.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$705.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$692.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,342.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$692.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.00
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
Urine Oxycodone Scrn FSI
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
8404560
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,176.40 |
| Max. Negotiated Rate |
$1,342.48 |
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Health Management Network Commercial |
$1,176.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,245.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,342.48
|
|
|
Urine Pregnancy Test POC
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 81025 QW
|
| Hospital Charge Code |
607612
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$8.74
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.75
|
| Rate for Payer: Health Management Network Commercial |
$54.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
