|
HC BX SKIN PUNCH LESION SNGL
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
3611110401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$480.23
|
| Rate for Payer: AlohaCare Medicare |
$480.23
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Devoted Health Medicare |
$528.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$600.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$480.23
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: Humana Medicare |
$480.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,001.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$480.23
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$528.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$480.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$480.23
|
| Rate for Payer: University Health Alliance Commercial |
$1,158.95
|
|
|
HC BX SKIN PUNCH LESION SNGL
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
3611110401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,351.50 |
| Max. Negotiated Rate |
$1,542.30 |
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Health Management Network Commercial |
$1,351.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,542.30
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: AlohaCare Medicaid |
$12.90
|
| Rate for Payer: AlohaCare Medicare |
$12.90
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Devoted Health Medicare |
$14.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.90
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$12.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.90
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.90
|
| Rate for Payer: University Health Alliance Commercial |
$21.40
|
|
|
HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 82365
|
| Hospital Charge Code |
3018236501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
|
|
HC CALPROTECTIN FECAL SO
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 83993
|
| Hospital Charge Code |
3018399301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: AlohaCare Medicaid |
$19.63
|
| Rate for Payer: AlohaCare Medicare |
$19.63
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Devoted Health Medicare |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.63
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Humana Medicare |
$19.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.63
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.63
|
| Rate for Payer: University Health Alliance Commercial |
$50.73
|
|
|
HC CALPROTECTIN FECAL SO
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 83993
|
| Hospital Charge Code |
3018399301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$140.25 |
| Max. Negotiated Rate |
$160.05 |
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: MDX Hawaii PPO |
$160.05
|
|
|
HC CALR EXON 9 ANALYSIS SO
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS 81219
|
| Hospital Charge Code |
3108121901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$989.40 |
| Rate for Payer: AlohaCare Medicaid |
$121.63
|
| Rate for Payer: AlohaCare Medicare |
$121.63
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Devoted Health Medicare |
$133.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$152.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$121.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.63
|
| Rate for Payer: Health Management Network Commercial |
$867.00
|
| Rate for Payer: Humana Medicare |
$121.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$520.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$121.63
|
| Rate for Payer: MDX Hawaii PPO |
$989.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$121.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$99.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$121.63
|
| Rate for Payer: University Health Alliance Commercial |
$743.48
|
|
|
HC CALR EXON 9 ANALYSIS SO
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS 81219
|
| Hospital Charge Code |
3108121901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$867.00 |
| Max. Negotiated Rate |
$989.40 |
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Health Management Network Commercial |
$867.00
|
| Rate for Payer: MDX Hawaii PPO |
$989.40
|
|
|
HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
3068748101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: AlohaCare Medicaid |
$35.09
|
| Rate for Payer: AlohaCare Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$38.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$29.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$185.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.09
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.09
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 87481
|
| Hospital Charge Code |
3068748101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$285.18 |
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Health Management Network Commercial |
$249.90
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
HC CARBOXYHEMOGLOBIN QUANTITATIVE SO
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
3018237502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: AlohaCare Medicaid |
$12.32
|
| Rate for Payer: AlohaCare Medicare |
$12.32
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Devoted Health Medicare |
$13.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.32
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Humana Medicare |
$12.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.32
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.32
|
| Rate for Payer: University Health Alliance Commercial |
$31.86
|
|
|
HC CARBOXYHEMOGLOBIN QUANTITATIVE SO
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 82375
|
| Hospital Charge Code |
3018237502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
|
|
HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
3018237801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: AlohaCare Medicaid |
$18.96
|
| Rate for Payer: AlohaCare Medicare |
$18.96
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$20.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.96
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Humana Medicare |
$18.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.96
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.96
|
| Rate for Payer: University Health Alliance Commercial |
$49.04
|
|
|
HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
3018237801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$154.23 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
|
|
HC CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
OP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$227.47 |
| Max. Negotiated Rate |
$1,166.91 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$227.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$281.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$409.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$1,022.55
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$757.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$613.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$1,166.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$227.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$928.77
|
|
|
HC CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
IP
|
$1,203.00
|
|
|
Service Code
|
HCPCS 75557
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,022.55 |
| Max. Negotiated Rate |
$1,166.91 |
| Rate for Payer: Cash Price |
$721.80
|
| Rate for Payer: Health Management Network Commercial |
$1,022.55
|
| Rate for Payer: MDX Hawaii PPO |
$1,166.91
|
|
|
HC CARDIAC MRI MORPH W/DYE - MRI CARD MORPH & FUNCT W & WO IV CONT
|
Facility
|
OP
|
$1,776.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
6107556101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: AlohaCare Medicaid |
$412.14
|
| Rate for Payer: AlohaCare Medicare |
$412.14
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Devoted Health Medicare |
$453.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$350.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$515.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$412.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$585.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$412.14
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: Humana Medicare |
$412.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,118.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$905.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$412.14
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$453.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$412.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$350.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$412.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,331.20
|
|
|
HC CARDIAC MRI MORPH W/DYE - MRI CARD MORPH & FUNCT W & WO IV CONT
|
Facility
|
IP
|
$1,776.00
|
|
|
Service Code
|
HCPCS 75561
|
| Hospital Charge Code |
6107556101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,509.60 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Health Management Network Commercial |
$1,509.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,722.72
|
|
|
HC CARDIAC SHUNT IMAGING - NM HEART SHUNT DETECTION
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78428
|
| Hospital Charge Code |
3417842801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$74.49 |
| 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 |
$74.49
|
| 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 |
$80.84
|
| 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 |
$74.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$369.30
|
|
|
HC CARDIAC SHUNT IMAGING - NM HEART SHUNT DETECTION
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78428
|
| Hospital Charge Code |
3417842801
|
|
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 CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION MULT
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$975.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION MULT
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION SING
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$975.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION SING
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,316.65 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301712
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$255.08
|
| Rate for Payer: AlohaCare Medicare |
$255.08
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$280.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$255.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,471.55
|
| Rate for Payer: Health Management Network Commercial |
$1,316.65
|
| Rate for Payer: Humana Medicare |
$255.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$975.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$255.08
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$280.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$255.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$255.08
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
