|
HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
9219397504
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$185.92 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$185.92
|
| 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 |
$222.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.90
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$701.20
|
|
|
HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
9219397504
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$817.70 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
|
|
HC VASC DUPLEX EXTREM VENOUS,BILAT
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
9219397006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$817.70 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
|
|
HC VASC DUPLEX EXTREM VENOUS,BILAT
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
9219397006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$139.85
|
| 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 |
$160.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.90
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$701.20
|
|
|
HC VASC DUPLEX LO EXTREM ART BILAT
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
9219392506
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$173.10 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$173.10
|
| 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 |
$206.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.90
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$701.20
|
|
|
HC VASC DUPLEX LO EXTREM ART BILAT
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
9219392506
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$817.70 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
|
|
HC VASC DUPLEX LO EXTREM ART UNILAT/LTD
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
9219392603
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
|
|
HC VASC DUPLEX LO EXTREM ART UNILAT/LTD
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
9219392603
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$123.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.85
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$308.32
|
|
|
HC VASC DUPLEX SCAN EXTRACRANIAL,BILAT
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
9219388005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$817.70 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
|
|
HC VASC DUPLEX SCAN EXTRACRANIAL,BILAT
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
9219388005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.03
|
| 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 |
$169.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.90
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$701.20
|
|
|
HC VASC DUPLEX SCAN EXTRACRANIAL,LIMITED
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
9219388204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$89.14 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.85
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$308.32
|
|
|
HC VASC DUPLEX SCAN EXTRACRANIAL,LIMITED
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
9219388204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
|
|
HC VASC DUPLEX UP EXTREM ART BILAT
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
HCPCS 93930
|
| Hospital Charge Code |
9219393006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$138.35 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: AlohaCare Medicaid |
$281.87
|
| Rate for Payer: AlohaCare Medicare |
$281.87
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Devoted Health Medicare |
$310.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.35
|
| 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 |
$165.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$913.90
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: Humana Medicare |
$281.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$606.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$490.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$281.87
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$310.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$281.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$281.87
|
| Rate for Payer: University Health Alliance Commercial |
$701.20
|
|
|
HC VASC DUPLEX UP EXTREM ART BILAT
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
HCPCS 93930
|
| Hospital Charge Code |
9219393006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$817.70 |
| Max. Negotiated Rate |
$933.14 |
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Health Management Network Commercial |
$817.70
|
| Rate for Payer: MDX Hawaii PPO |
$933.14
|
|
|
HC VASC DUPLEX UP EXTREM ART UNILAT/LTD
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
9219393103
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.01 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: AlohaCare Medicaid |
$123.50
|
| Rate for Payer: AlohaCare Medicare |
$123.50
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Devoted Health Medicare |
$135.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.01
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$123.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$107.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$401.85
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: Humana Medicare |
$123.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$266.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$215.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$123.50
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$123.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$123.50
|
| Rate for Payer: University Health Alliance Commercial |
$308.32
|
|
|
HC VASC DUPLEX UP EXTREM ART UNILAT/LTD
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
HCPCS 93931
|
| Hospital Charge Code |
9219393103
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$410.31 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Health Management Network Commercial |
$359.55
|
| Rate for Payer: MDX Hawaii PPO |
$410.31
|
|
|
HC VASC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
9219392203
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$436.05 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
|
|
HC VASC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
9219392203
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$497.61 |
| Rate for Payer: AlohaCare Medicaid |
$157.18
|
| Rate for Payer: AlohaCare Medicare |
$157.18
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Devoted Health Medicare |
$172.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$68.30
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$196.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$157.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$81.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$487.35
|
| Rate for Payer: Health Management Network Commercial |
$436.05
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$261.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$157.18
|
| Rate for Payer: MDX Hawaii PPO |
$497.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$172.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$157.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$157.18
|
| Rate for Payer: University Health Alliance Commercial |
$373.93
|
|
|
HC VASCULAR BIOPSY - IR TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$2,725.00
|
|
|
Service Code
|
HCPCS 75970
|
| Hospital Charge Code |
3207597001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,316.25 |
| Max. Negotiated Rate |
$2,643.25 |
| Rate for Payer: Cash Price |
$1,635.00
|
| Rate for Payer: Health Management Network Commercial |
$2,316.25
|
| Rate for Payer: MDX Hawaii PPO |
$2,643.25
|
|
|
HC VASCULAR BIOPSY - IR TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
HCPCS 75970
|
| Hospital Charge Code |
3207597001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.14 |
| Max. Negotiated Rate |
$2,643.25 |
| Rate for Payer: Cash Price |
$1,635.00
|
| Rate for Payer: Cash Price |
$1,635.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$380.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$412.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,588.75
|
| Rate for Payer: Health Management Network Commercial |
$2,316.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,716.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,389.75
|
| Rate for Payer: MDX Hawaii PPO |
$2,643.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$380.14
|
| Rate for Payer: University Health Alliance Commercial |
$1,986.25
|
|
|
HC VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Facility
|
OP
|
$71,461.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
3603724201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$69,317.17 |
| Rate for Payer: AlohaCare Medicaid |
$21,655.98
|
| Rate for Payer: AlohaCare Medicare |
$21,655.98
|
| Rate for Payer: Cash Price |
$42,876.60
|
| Rate for Payer: Cash Price |
$42,876.60
|
| Rate for Payer: Cash Price |
$42,876.60
|
| Rate for Payer: Devoted Health Medicare |
$23,821.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,395.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21,655.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2,695.11
|
| Rate for Payer: Health Management Network Commercial |
$60,741.85
|
| Rate for Payer: Humana Medicare |
$21,655.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$45,020.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$21,655.98
|
| Rate for Payer: MDX Hawaii PPO |
$69,317.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23,821.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$21,655.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$21,655.98
|
| Rate for Payer: University Health Alliance Commercial |
$24,500.00
|
|
|
HC VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Facility
|
IP
|
$71,461.00
|
|
|
Service Code
|
HCPCS 37242
|
| Hospital Charge Code |
3603724201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60,741.85 |
| Max. Negotiated Rate |
$69,317.17 |
| Rate for Payer: Cash Price |
$42,876.60
|
| Rate for Payer: Health Management Network Commercial |
$60,741.85
|
| Rate for Payer: MDX Hawaii PPO |
$69,317.17
|
|
|
HC VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Facility
|
OP
|
$45,131.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
3603724401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$43,777.07 |
| Rate for Payer: AlohaCare Medicaid |
$13,637.67
|
| Rate for Payer: AlohaCare Medicare |
$13,637.67
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Devoted Health Medicare |
$15,001.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,047.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13,637.67
|
| Rate for Payer: Health Management Network Commercial |
$38,361.35
|
| Rate for Payer: Humana Medicare |
$13,637.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$28,432.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13,637.67
|
| Rate for Payer: MDX Hawaii PPO |
$43,777.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,001.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$13,637.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$13,637.67
|
| Rate for Payer: University Health Alliance Commercial |
$32,895.99
|
|
|
HC VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Facility
|
IP
|
$45,131.00
|
|
|
Service Code
|
HCPCS 37244
|
| Hospital Charge Code |
3603724401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$38,361.35 |
| Max. Negotiated Rate |
$43,777.07 |
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Health Management Network Commercial |
$38,361.35
|
| Rate for Payer: MDX Hawaii PPO |
$43,777.07
|
|
|
HC VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Facility
|
OP
|
$45,131.00
|
|
|
Service Code
|
HCPCS 37241
|
| Hospital Charge Code |
3603724101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.55 |
| Max. Negotiated Rate |
$43,777.07 |
| Rate for Payer: AlohaCare Medicaid |
$13,637.67
|
| Rate for Payer: AlohaCare Medicare |
$13,637.67
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Cash Price |
$27,078.60
|
| Rate for Payer: Devoted Health Medicare |
$15,001.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,047.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13,637.67
|
| Rate for Payer: Health Management Network Commercial |
$38,361.35
|
| Rate for Payer: Humana Medicare |
$13,637.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$28,432.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$13,637.67
|
| Rate for Payer: MDX Hawaii PPO |
$43,777.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15,001.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$13,637.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$644.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$13,637.67
|
| Rate for Payer: University Health Alliance Commercial |
$13,923.44
|
|
