|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
|
|
HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
3018280301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$212.43 |
| Rate for Payer: AlohaCare Medicaid |
$109.50
|
| Rate for Payer: AlohaCare Medicare |
$166.44
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Devoted Health Medicare |
$183.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$28.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$186.15
|
| Rate for Payer: Humana Medicare |
$166.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$197.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.44
|
| Rate for Payer: MDX Hawaii PPO |
$212.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.44
|
| Rate for Payer: University Health Alliance Commercial |
$50.02
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
3018227002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: AlohaCare Medicaid |
$18.50
|
| Rate for Payer: AlohaCare Medicare |
$28.12
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Devoted Health Medicare |
$31.08
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Humana Medicare |
$28.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$18.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.12
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.12
|
| Rate for Payer: University Health Alliance Commercial |
$8.40
|
|
|
HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - FECAL IMM
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
3018227002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Health Management Network Commercial |
$31.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.30
|
| Rate for Payer: MDX Hawaii PPO |
$35.89
|
|
|
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$67.00
|
| Rate for Payer: AlohaCare Medicare |
$101.84
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$112.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.33
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.92
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$101.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.84
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.84
|
| Rate for Payer: University Health Alliance Commercial |
$41.11
|
|
|
HC BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS 82274
|
| Hospital Charge Code |
3018227401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
|
|
HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: AlohaCare Medicaid |
$16.00
|
| Rate for Payer: AlohaCare Medicare |
$24.32
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Devoted Health Medicare |
$26.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.76
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$24.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.32
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.32
|
| Rate for Payer: University Health Alliance Commercial |
$8.90
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
3008905102
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$35.72
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$39.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.60
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$35.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.72
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.72
|
| Rate for Payer: University Health Alliance Commercial |
$14.24
|
|
|
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 |
$450.00 |
| Max. Negotiated Rate |
$6,518.40 |
| Rate for Payer: AlohaCare Medicaid |
$3,360.00
|
| Rate for Payer: AlohaCare Medicare |
$5,107.20
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Devoted Health Medicare |
$5,644.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5,107.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| 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 |
$5,107.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,048.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$5,107.20
|
| Rate for Payer: MDX Hawaii PPO |
$6,518.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5,107.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$5,107.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$5,107.20
|
| Rate for Payer: University Health Alliance Commercial |
$5,160.40
|
|
|
HC BRONCHOSCOPY,REMV FOR. BODY
|
Facility
|
IP
|
$6,720.00
|
|
|
Service Code
|
HCPCS 31635
|
| Hospital Charge Code |
7613163501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,712.00 |
| Max. Negotiated Rate |
$6,518.40 |
| Rate for Payer: Cash Price |
$4,032.00
|
| Rate for Payer: Health Management Network Commercial |
$5,712.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,048.00
|
| Rate for Payer: MDX Hawaii PPO |
$6,518.40
|
|
|
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: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
|
|
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 |
$147.00
|
| Rate for Payer: AlohaCare Medicare |
$223.44
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Devoted Health Medicare |
$246.96
|
| 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 |
$223.44
|
| 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 |
$223.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$223.44
|
| Rate for Payer: MDX Hawaii PPO |
$285.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.44
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
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 |
$79.50
|
| Rate for Payer: AlohaCare Medicare |
$120.84
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Devoted Health Medicare |
$133.56
|
| 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 |
$120.84
|
| 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 |
$120.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$120.84
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$120.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$120.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$120.84
|
| 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: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
|
|
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 |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$1,177.24
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,177.24
|
| 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 |
$1,177.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,177.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.24
|
| 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: Kaiser Permanente Commercial |
$1,394.10
|
| 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 |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$1,177.24
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,177.24
|
| 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 |
$1,177.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,177.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.24
|
| 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: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301712
|
|
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: Kaiser Permanente Commercial |
$1,394.10
|
| 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 |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$1,177.24
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,177.24
|
| 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 |
$1,177.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,177.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301711
|
|
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: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
4829301711
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,502.53 |
| Rate for Payer: AlohaCare Medicaid |
$774.50
|
| Rate for Payer: AlohaCare Medicare |
$1,177.24
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Cash Price |
$929.40
|
| Rate for Payer: Devoted Health Medicare |
$1,301.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,177.24
|
| 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 |
$1,177.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,394.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$789.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,177.24
|
| Rate for Payer: MDX Hawaii PPO |
$1,502.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,177.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,177.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,177.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,129.07
|
|
|
HC CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
9189616101
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$115.43 |
| Rate for Payer: AlohaCare Medicaid |
$59.50
|
| Rate for Payer: AlohaCare Medicare |
$90.44
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Devoted Health Medicare |
$99.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$47.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.05
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Humana Medicare |
$90.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.44
|
| Rate for Payer: MDX Hawaii PPO |
$115.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.44
|
| Rate for Payer: University Health Alliance Commercial |
$86.74
|
|
