|
HC BONE MARROW IMAGING, BODY - NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78104
|
| Hospital Charge Code |
3417810401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$798.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$485.96
|
|
|
HC BONE MARROW IMAGING, BODY - NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78104
|
| Hospital Charge Code |
3417810401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,331.10 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
|
|
HC BONE MARROW IMAGING, LTD - NM BONE MARROW LIMITED
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78102
|
| Hospital Charge Code |
3417810201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$67.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$73.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$798.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$67.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$298.18
|
|
|
HC BONE MARROW IMAGING, LTD - NM BONE MARROW LIMITED
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78102
|
| Hospital Charge Code |
3417810201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,331.10 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
|
|
HC BONE MARROW IMAGING, MULT - NM BONE MARROW MULTIPLE AREAS
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78103
|
| Hospital Charge Code |
3417810301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.57 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$104.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$113.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$798.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$104.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$412.49
|
|
|
HC BONE MARROW IMAGING, MULT - NM BONE MARROW MULTIPLE AREAS
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78103
|
| Hospital Charge Code |
3417810301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,331.10 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
|
|
HC BOWEL IMAGING - NM MECKELS DIVERTICULUM
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
3417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$100.26
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$109.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$525.51
|
|
|
HC BOWEL IMAGING - NM MECKELS DIVERTICULUM
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78290
|
| Hospital Charge Code |
3417829001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC BRAF GENE ANALYSIS SO
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS 81210
|
| Hospital Charge Code |
3108121001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: AlohaCare Medicaid |
$175.40
|
| Rate for Payer: AlohaCare Medicare |
$175.40
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Devoted Health Medicare |
$192.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$175.87
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$219.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$175.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.40
|
| Rate for Payer: Health Management Network Commercial |
$1,251.20
|
| Rate for Payer: Humana Medicare |
$175.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$927.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$750.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,427.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,072.94
|
|
|
HC BRAF GENE ANALYSIS SO
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS 81210
|
| Hospital Charge Code |
3108121001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,251.20 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Health Management Network Commercial |
$1,251.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,427.84
|
|
|
HC BRAIN FLOW IMAGING ONLY - NM BRAIN FLOW ONLY BRAIN DEATH
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78610
|
| Hospital Charge Code |
3417861001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$363.65
|
|
|
HC BRAIN FLOW IMAGING ONLY - NM BRAIN FLOW ONLY BRAIN DEATH
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78610
|
| Hospital Charge Code |
3417861001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC BRAIN FLOW IMAGING ONLY - NM CEREBRAL FLOW
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78610
|
| Hospital Charge Code |
3417861002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$52.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$363.65
|
|
|
HC BRAIN FLOW IMAGING ONLY - NM CEREBRAL FLOW
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78610
|
| Hospital Charge Code |
3417861002
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC BRAIN IMAGE 4+ VIEWS - NM BRAIN 4 OR MORE VIEWS
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78605
|
| Hospital Charge Code |
3417860501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC BRAIN IMAGE 4+ VIEWS - NM BRAIN 4 OR MORE VIEWS
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78605
|
| Hospital Charge Code |
3417860501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$111.99 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$381.47
|
|
|
HC BRAIN IMAGE < 4 VIEWS - NM BRAIN LIMITED
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78600
|
| Hospital Charge Code |
3417860001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,331.10 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
|
|
HC BRAIN IMAGE < 4 VIEWS - NM BRAIN LIMITED
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 78600
|
| Hospital Charge Code |
3417860001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$94.70 |
| Max. Negotiated Rate |
$1,519.02 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$94.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$103.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,331.10
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$986.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$798.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$332.91
|
|
|
HC BRAIN IMAGE W/FLOW 4 + VIEWS - NM BRAIN WITH FLOW 4 OR MORE VIEWS
|
Facility
|
OP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78606
|
| Hospital Charge Code |
3417860601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$127.46 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$801.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$641.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$138.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,687.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,365.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$557.29
|
|
|
HC BRAIN IMAGE W/FLOW 4 + VIEWS - NM BRAIN WITH FLOW 4 OR MORE VIEWS
|
Facility
|
IP
|
$2,678.00
|
|
|
Service Code
|
HCPCS 78606
|
| Hospital Charge Code |
3417860601
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,276.30 |
| Max. Negotiated Rate |
$2,597.66 |
| Rate for Payer: Cash Price |
$1,606.80
|
| Rate for Payer: Health Management Network Commercial |
$2,276.30
|
| Rate for Payer: MDX Hawaii PPO |
$2,597.66
|
|
|
HC BRAIN IMAGE W/FLOW < 4 VIEWS - NM BRAIN WITH FLOW LESS THAN 4 VIEWS
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78601
|
| Hospital Charge Code |
3417860101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$111.99 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: AlohaCare Medicaid |
$472.27
|
| Rate for Payer: AlohaCare Medicare |
$472.27
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Devoted Health Medicare |
$519.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$111.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$590.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$472.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$121.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$472.27
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: Humana Medicare |
$472.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,259.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,019.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$472.27
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$519.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$472.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$400.08
|
|
|
HC BRAIN IMAGE W/FLOW < 4 VIEWS - NM BRAIN WITH FLOW LESS THAN 4 VIEWS
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78601
|
| Hospital Charge Code |
3417860101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,699.15 |
| Max. Negotiated Rate |
$1,939.03 |
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Health Management Network Commercial |
$1,699.15
|
| Rate for Payer: MDX Hawaii PPO |
$1,939.03
|
|
|
HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$604.31 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$591.85
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$392.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$317.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$604.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$454.10
|
|
|
HC BREATHING CAPACITY TEST - OFFICE SPIROMETRY
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
4609401001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$529.55 |
| Max. Negotiated Rate |
$604.31 |
| Rate for Payer: Cash Price |
$373.80
|
| Rate for Payer: Health Management Network Commercial |
$529.55
|
| Rate for Payer: MDX Hawaii PPO |
$604.31
|
|
|
HC BRONCHOSCOPY,REMV FOR. BODY
|
Facility
|
OP
|
$6,720.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
7613163501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$6,518.40 |
| Rate for Payer: AlohaCare Medicaid |
$2,102.67
|
| Rate for Payer: AlohaCare Medicare |
$2,102.67
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Devoted Health Medicare |
$2,312.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$695.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5,509.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,102.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,028.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,384.00
|
| Rate for Payer: Health Management Network Commercial |
$5,712.00
|
| Rate for Payer: Humana Medicare |
$2,102.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,233.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,102.67
|
| Rate for Payer: MDX Hawaii PPO |
$6,518.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,312.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,102.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,102.67
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
