|
DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 90696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Cash Price |
$81.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.12
|
| Rate for Payer: Health Management Network Commercial |
$106.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.00
|
|
|
D-Test Clindamycin Resistance DLS
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
422871845
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
|
|
D-Test Clindamycin Resistance DLS
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 87184
|
| Hospital Charge Code |
422871845
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: AlohaCare Medicaid |
$44.00
|
| Rate for Payer: AlohaCare Medicare |
$36.96
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Cash Price |
$57.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$80.96
|
| Rate for Payer: Devoted Health Medicare |
$36.96
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$9.53
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.48
|
| Rate for Payer: Health Management Network Commercial |
$74.80
|
| Rate for Payer: Humana Medicare |
$36.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.96
|
| Rate for Payer: MDX Hawaii PPO |
$85.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.96
|
| Rate for Payer: University Health Alliance Commercial |
$17.82
|
|
|
dulaglutide 0.75 mg/0.5 mL Sol UD [KMC]
|
Facility
|
OP
|
$1,065.42
|
|
|
Service Code
|
NDC 00002143380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$447.48 |
| Max. Negotiated Rate |
$1,033.46 |
| Rate for Payer: AlohaCare Medicaid |
$532.71
|
| Rate for Payer: AlohaCare Medicare |
$447.48
|
| Rate for Payer: Cash Price |
$692.52
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$980.19
|
| Rate for Payer: Devoted Health Medicare |
$447.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,012.15
|
| Rate for Payer: Health Management Network Commercial |
$905.61
|
| Rate for Payer: Humana Medicare |
$447.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$958.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$543.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.48
|
| Rate for Payer: MDX Hawaii PPO |
$1,033.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$447.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$639.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.48
|
| Rate for Payer: University Health Alliance Commercial |
$776.58
|
|
|
dulaglutide 0.75 mg/0.5 mL Sol UD [KMC]
|
Facility
|
IP
|
$1,065.42
|
|
|
Service Code
|
NDC 00002143380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$905.61 |
| Max. Negotiated Rate |
$1,033.46 |
| Rate for Payer: Cash Price |
$692.52
|
| Rate for Payer: Health Management Network Commercial |
$905.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$958.88
|
| Rate for Payer: MDX Hawaii PPO |
$1,033.46
|
|
|
dulaglutide 1.5 mg/0.5 mL Sol UD
|
Facility
|
IP
|
$1,354.31
|
|
|
Service Code
|
NDC 00002143480
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,151.16 |
| Max. Negotiated Rate |
$1,313.68 |
| Rate for Payer: Cash Price |
$880.30
|
| Rate for Payer: Health Management Network Commercial |
$1,151.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,218.88
|
| Rate for Payer: MDX Hawaii PPO |
$1,313.68
|
|
|
dulaglutide 1.5 mg/0.5 mL Sol UD
|
Facility
|
OP
|
$1,354.31
|
|
|
Service Code
|
NDC 00002143480
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$568.81 |
| Max. Negotiated Rate |
$1,313.68 |
| Rate for Payer: AlohaCare Medicaid |
$677.15
|
| Rate for Payer: AlohaCare Medicare |
$568.81
|
| Rate for Payer: Cash Price |
$880.30
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,245.97
|
| Rate for Payer: Devoted Health Medicare |
$568.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$568.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,286.59
|
| Rate for Payer: Health Management Network Commercial |
$1,151.16
|
| Rate for Payer: Humana Medicare |
$568.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,218.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$690.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$568.81
|
| Rate for Payer: MDX Hawaii PPO |
$1,313.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$568.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$568.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$812.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$568.81
|
| Rate for Payer: University Health Alliance Commercial |
$987.16
|
|
|
dulaglutide 3 mg/0.5 mL Soln [KMC]
|
Facility
|
IP
|
$2,127.74
|
|
|
Service Code
|
NDC 00002223680
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,808.58 |
| Max. Negotiated Rate |
$2,063.91 |
| Rate for Payer: Cash Price |
$1,383.03
|
| Rate for Payer: Health Management Network Commercial |
$1,808.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,914.97
|
| Rate for Payer: MDX Hawaii PPO |
$2,063.91
|
|
|
dulaglutide 3 mg/0.5 mL Soln [KMC]
|
Facility
|
OP
|
$2,127.74
|
|
|
Service Code
|
NDC 00002223680
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$893.65 |
| Max. Negotiated Rate |
$2,063.91 |
| Rate for Payer: AlohaCare Medicaid |
$1,063.87
|
| Rate for Payer: AlohaCare Medicare |
$893.65
|
| Rate for Payer: Cash Price |
$1,383.03
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$1,957.52
|
| Rate for Payer: Devoted Health Medicare |
$893.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$893.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,021.35
|
| Rate for Payer: Health Management Network Commercial |
$1,808.58
|
| Rate for Payer: Humana Medicare |
$893.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,914.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,085.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$893.65
|
| Rate for Payer: MDX Hawaii PPO |
$2,063.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$893.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$893.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,276.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$893.65
|
| Rate for Payer: University Health Alliance Commercial |
$1,550.91
|
|
|
DULoxetine 20 mg DR cap [KMC]
|
Facility
|
IP
|
$27.99
|
|
|
Service Code
|
NDC 00228289006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Health Management Network Commercial |
$23.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.19
|
| Rate for Payer: MDX Hawaii PPO |
$27.15
|
|
|
DULoxetine 20 mg DR cap [KMC]
|
Facility
|
OP
|
$27.99
|
|
|
Service Code
|
NDC 00228289006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$27.15 |
| Rate for Payer: AlohaCare Medicaid |
$13.99
|
| Rate for Payer: AlohaCare Medicare |
$11.76
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$25.75
|
| Rate for Payer: Devoted Health Medicare |
$11.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.59
|
| Rate for Payer: Health Management Network Commercial |
$23.79
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.76
|
| Rate for Payer: MDX Hawaii PPO |
$27.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.76
|
| Rate for Payer: University Health Alliance Commercial |
$20.40
|
|
|
DULoxetine 30 mg DR cap [KMC]
|
Facility
|
OP
|
$31.41
|
|
|
Service Code
|
NDC 68180029506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$30.47 |
| Rate for Payer: AlohaCare Medicaid |
$15.71
|
| Rate for Payer: AlohaCare Medicare |
$13.19
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$28.90
|
| Rate for Payer: Devoted Health Medicare |
$13.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.84
|
| Rate for Payer: Health Management Network Commercial |
$26.70
|
| Rate for Payer: Humana Medicare |
$13.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.19
|
| Rate for Payer: MDX Hawaii PPO |
$30.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.19
|
| Rate for Payer: University Health Alliance Commercial |
$22.89
|
|
|
DULoxetine 30 mg DR cap [KMC]
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
NDC 68180029506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$30.47 |
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Health Management Network Commercial |
$26.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.27
|
| Rate for Payer: MDX Hawaii PPO |
$30.47
|
|
|
DULoxetine 60 mg DR Cap [KMC]
|
Facility
|
OP
|
$6.89
|
|
|
Service Code
|
NDC 00904704561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: AlohaCare Medicaid |
$3.44
|
| Rate for Payer: AlohaCare Medicare |
$2.89
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$6.34
|
| Rate for Payer: Devoted Health Medicare |
$2.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.55
|
| Rate for Payer: Health Management Network Commercial |
$5.86
|
| Rate for Payer: Humana Medicare |
$2.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.89
|
| Rate for Payer: MDX Hawaii PPO |
$6.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.89
|
| Rate for Payer: University Health Alliance Commercial |
$5.02
|
|
|
DULoxetine 60 mg DR Cap [KMC]
|
Facility
|
IP
|
$6.89
|
|
|
Service Code
|
NDC 00904704561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Health Management Network Commercial |
$5.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.20
|
| Rate for Payer: MDX Hawaii PPO |
$6.68
|
|
|
DUODERM 4"X4"
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
8407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$7.98
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$17.48
|
| Rate for Payer: Devoted Health Medicare |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.98
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.98
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
DUODERM 4"X4"
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
8407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
Duplex scan of extracranial arteries; complete bilateral study
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
424938809
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$155.20 |
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Health Management Network Commercial |
$142.80
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.20
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: MDX Hawaii PPO |
$162.96
|
|
|
Duplex scan of extracranial arteries; complete bilateral study
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
424938809
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$352.34 |
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicaid |
$84.00
|
| Rate for Payer: AlohaCare Medicare |
$70.56
|
| Rate for Payer: AlohaCare Medicare |
$67.20
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$154.56
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$147.20
|
| Rate for Payer: Devoted Health Medicare |
$67.20
|
| Rate for Payer: Devoted Health Medicare |
$70.56
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$142.03
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$142.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$152.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network Commercial |
$142.80
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Humana Medicare |
$67.20
|
| Rate for Payer: Humana Medicare |
$70.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.20
|
| Rate for Payer: MDX Hawaii PPO |
$155.20
|
| Rate for Payer: MDX Hawaii PPO |
$162.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.56
|
| Rate for Payer: University Health Alliance Commercial |
$116.62
|
| Rate for Payer: University Health Alliance Commercial |
$122.46
|
|
|
Duplex scan of extracranial arteries; unilateral or limited study
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
424938829
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$104.76 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
|
|
Duplex scan of extracranial arteries; unilateral or limited study
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
424938829
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$154.38 |
| Rate for Payer: AlohaCare Medicaid |
$50.00
|
| Rate for Payer: AlohaCare Medicaid |
$54.00
|
| Rate for Payer: AlohaCare Medicare |
$45.36
|
| Rate for Payer: AlohaCare Medicare |
$42.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$92.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$99.36
|
| Rate for Payer: Devoted Health Medicare |
$45.36
|
| Rate for Payer: Devoted Health Medicare |
$42.00
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$89.14
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$89.14
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.00
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
| Rate for Payer: Health Management Network Commercial |
$91.80
|
| Rate for Payer: Humana Medicare |
$45.36
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.00
|
| Rate for Payer: MDX Hawaii PPO |
$104.76
|
| Rate for Payer: MDX Hawaii PPO |
$97.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.00
|
| Rate for Payer: University Health Alliance Commercial |
$72.89
|
| Rate for Payer: University Health Alliance Commercial |
$78.72
|
|
|
Duplex scan of extremity veins including responses to compre
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
424939719
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$154.38 |
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$39.90
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$87.40
|
| Rate for Payer: Devoted Health Medicare |
$39.90
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$93.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Humana Medicare |
$39.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.90
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.90
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
Duplex scan of extremity veins including responses to compre
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
424939709
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
|
|
Duplex scan of extremity veins including responses to compre
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
424939709
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$352.34 |
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$39.90
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$87.40
|
| Rate for Payer: Devoted Health Medicare |
$39.90
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$139.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Humana Medicare |
$39.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.90
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.90
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
Duplex scan of extremity veins including responses to compre
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
424939719
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$80.75 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
|
