|
HC TTE W/O DOPPLER COMPLETE - TRANSTHORACIC ECHO (TTE) COMPLETE
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
4839330701
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$408.37 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.90
|
| 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 |
$134.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$399.95
|
| Rate for Payer: Health Management Network Commercial |
$357.85
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$408.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$306.87
|
|
|
HC TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
OP
|
$6,182.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
3613255101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$5,996.54 |
| Rate for Payer: AlohaCare Medicaid |
$1,859.62
|
| Rate for Payer: AlohaCare Medicare |
$1,859.62
|
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Devoted Health Medicare |
$2,045.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,536.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,859.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$496.75
|
| Rate for Payer: Health Management Network Commercial |
$5,254.70
|
| Rate for Payer: Humana Medicare |
$1,859.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,894.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,859.62
|
| Rate for Payer: MDX Hawaii PPO |
$5,996.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,045.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,859.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,859.62
|
| Rate for Payer: University Health Alliance Commercial |
$4,506.06
|
|
|
HC TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Facility
|
IP
|
$6,182.00
|
|
|
Service Code
|
HCPCS 32551
|
| Hospital Charge Code |
3613255101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,254.70 |
| Max. Negotiated Rate |
$5,996.54 |
| Rate for Payer: Cash Price |
$3,709.20
|
| Rate for Payer: Health Management Network Commercial |
$5,254.70
|
| Rate for Payer: MDX Hawaii PPO |
$5,996.54
|
|
|
HC TUMOR IMAGING (3D) - NM TUMOR LOCALIZATION SPECT
|
Facility
|
OP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
3417880301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$216.28 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$216.28
|
| 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 |
$234.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,091.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,311.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$216.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$708.25
|
|
|
HC TUMOR IMAGING (3D) - NM TUMOR LOCALIZATION SPECT
|
Facility
|
IP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78803
|
| Hospital Charge Code |
3417880301
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,519.90 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
|
|
HC TUMOR IMAGING, LIMITED AREA - NM TUMOR LOCALIZATION LIMITED
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
3417880001
|
|
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 TUMOR IMAGING, LIMITED AREA - NM TUMOR LOCALIZATION LIMITED
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78800
|
| Hospital Charge Code |
3417880001
|
|
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 |
$371.81
|
|
|
HC TUMOR IMAGING, MULT AREAS - NM TUMOR LOCALIZATION MULTIPLE AREAS
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
3417880102
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.19 |
| 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 |
$139.19
|
| 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 |
$151.22
|
| 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 |
$139.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$485.38
|
|
|
HC TUMOR IMAGING, MULT AREAS - NM TUMOR LOCALIZATION MULTIPLE AREAS
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
3417880102
|
|
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 TUMOR IMAGING, MULT AREAS - NM TUMOR OCTREOSCAN
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
3417880101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$139.19 |
| 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 |
$139.19
|
| 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 |
$151.22
|
| 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 |
$139.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$472.27
|
| Rate for Payer: University Health Alliance Commercial |
$485.38
|
|
|
HC TUMOR IMAGING, MULT AREAS - NM TUMOR OCTREOSCAN
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
HCPCS 78801
|
| Hospital Charge Code |
3417880101
|
|
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 TUMOR IMAGING WHOLE BODY - NM TUMOR LOCALIZATION WHOLE BODY
|
Facility
|
OP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3417880203
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$182.43 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$182.43
|
| 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 |
$197.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,091.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,311.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$182.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$630.18
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCALIZATION WHOLE BODY
|
Facility
|
IP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3417880203
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,519.90 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY MULT DAYS
|
Facility
|
OP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
3417880401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$285.62
|
| 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 |
$341.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,091.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,311.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$285.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$1,136.40
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY MULT DAYS
|
Facility
|
IP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78804
|
| Hospital Charge Code |
3417880401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,519.90 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY W GALLIUM
|
Facility
|
OP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3417880201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$182.43 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$182.43
|
| 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 |
$197.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,091.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,311.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$182.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$630.18
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY W GALLIUM
|
Facility
|
IP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3417880201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,519.90 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY W OCTREOSCAN
|
Facility
|
OP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3417880202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$182.43 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: AlohaCare Medicaid |
$641.43
|
| Rate for Payer: AlohaCare Medicare |
$641.43
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Devoted Health Medicare |
$705.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$182.43
|
| 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 |
$197.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$641.43
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: Humana Medicare |
$641.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$4,091.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,311.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$641.43
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$705.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$641.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$182.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$641.43
|
| Rate for Payer: University Health Alliance Commercial |
$630.18
|
|
|
HC TUMOR IMAGING WHOLE BODY - NM TUMOR LOCAL WHOLE BODY W OCTREOSCAN
|
Facility
|
IP
|
$6,494.00
|
|
|
Service Code
|
HCPCS 78802
|
| Hospital Charge Code |
3417880202
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,519.90 |
| Max. Negotiated Rate |
$6,299.18 |
| Rate for Payer: Cash Price |
$3,896.40
|
| Rate for Payer: Health Management Network Commercial |
$5,519.90
|
| Rate for Payer: MDX Hawaii PPO |
$6,299.18
|
|
|
HC TX DEV DSGN/FAB COMPLEX
|
Facility
|
OP
|
$1,457.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
3337733401
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$114.46 |
| Max. Negotiated Rate |
$1,413.29 |
| Rate for Payer: AlohaCare Medicaid |
$442.33
|
| Rate for Payer: AlohaCare Medicare |
$442.33
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Devoted Health Medicare |
$486.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$114.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$552.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$120.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$442.33
|
| Rate for Payer: Health Management Network Commercial |
$1,238.45
|
| Rate for Payer: Humana Medicare |
$442.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$917.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$743.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$442.33
|
| Rate for Payer: MDX Hawaii PPO |
$1,413.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$486.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.33
|
| Rate for Payer: University Health Alliance Commercial |
$343.42
|
|
|
HC TX DEV DSGN/FAB COMPLEX
|
Facility
|
IP
|
$1,457.00
|
|
|
Service Code
|
HCPCS 77334
|
| Hospital Charge Code |
3337733401
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,238.45 |
| Max. Negotiated Rate |
$1,413.29 |
| Rate for Payer: Cash Price |
$874.20
|
| Rate for Payer: Health Management Network Commercial |
$1,238.45
|
| Rate for Payer: MDX Hawaii PPO |
$1,413.29
|
|
|
HC TX DEV DSGN/FAB INT
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
3337733301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$167.22
|
|
|
HC TX DEV DSGN/FAB INT
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 77333
|
| Hospital Charge Code |
3337733301
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
|
HC TX DEV DSGN/FAB SIMPLE
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
3337733201
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: AlohaCare Medicaid |
$158.78
|
| Rate for Payer: AlohaCare Medicare |
$158.78
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Devoted Health Medicare |
$174.66
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$198.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$158.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$49.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.78
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: Humana Medicare |
$158.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$332.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$269.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$158.78
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$158.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$158.78
|
| Rate for Payer: University Health Alliance Commercial |
$161.54
|
|
|
HC TX DEV DSGN/FAB SIMPLE
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 77332
|
| Hospital Charge Code |
3337733201
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$512.16 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Management Network Commercial |
$448.80
|
| Rate for Payer: MDX Hawaii PPO |
$512.16
|
|
