|
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
424939709
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$62.58 |
| Max. Negotiated Rate |
$352.34 |
| Rate for Payer: AlohaCare Medicaid |
$74.50
|
| Rate for Payer: AlohaCare Medicare |
$62.58
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$137.08
|
| Rate for Payer: Devoted Health Medicare |
$62.58
|
| 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 |
$62.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$141.55
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Humana Medicare |
$62.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.58
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.58
|
| Rate for Payer: University Health Alliance Commercial |
$108.61
|
|
|
Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
424939709
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$126.65 |
| Max. Negotiated Rate |
$144.53 |
| Rate for Payer: Cash Price |
$96.85
|
| Rate for Payer: Health Management Network Commercial |
$126.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.10
|
| Rate for Payer: MDX Hawaii PPO |
$144.53
|
|
|
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
|
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: Cash Price |
$59.15
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
|
|
Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
424939719
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$154.38 |
| Rate for Payer: AlohaCare Medicaid |
$45.50
|
| Rate for Payer: AlohaCare Medicaid |
$47.50
|
| Rate for Payer: AlohaCare Medicare |
$39.90
|
| Rate for Payer: AlohaCare Medicare |
$38.22
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$59.15
|
| Rate for Payer: Cash Price |
$61.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$83.72
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$87.40
|
| Rate for Payer: Devoted Health Medicare |
$39.90
|
| Rate for Payer: Devoted Health Medicare |
$38.22
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$93.10
|
| 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 Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$90.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.45
|
| Rate for Payer: Health Management Network Commercial |
$77.35
|
| Rate for Payer: Health Management Network Commercial |
$80.75
|
| Rate for Payer: Humana Medicare |
$39.90
|
| Rate for Payer: Humana Medicare |
$38.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.22
|
| Rate for Payer: MDX Hawaii PPO |
$92.15
|
| Rate for Payer: MDX Hawaii PPO |
$88.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.22
|
| Rate for Payer: University Health Alliance Commercial |
$66.33
|
| Rate for Payer: University Health Alliance Commercial |
$69.25
|
|
|
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
424939259
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$66.36 |
| Max. Negotiated Rate |
$352.34 |
| Rate for Payer: AlohaCare Medicaid |
$79.00
|
| Rate for Payer: AlohaCare Medicaid |
$83.50
|
| Rate for Payer: AlohaCare Medicare |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$66.36
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$145.36
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$153.64
|
| Rate for Payer: Devoted Health Medicare |
$70.14
|
| Rate for Payer: Devoted Health Medicare |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$173.10
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$173.10
|
| 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 |
$66.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.10
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| Rate for Payer: Humana Medicare |
$70.14
|
| Rate for Payer: Humana Medicare |
$66.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.36
|
| Rate for Payer: MDX Hawaii PPO |
$161.99
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.36
|
| Rate for Payer: University Health Alliance Commercial |
$115.17
|
| Rate for Payer: University Health Alliance Commercial |
$121.73
|
|
|
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
424939259
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$141.95 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: Cash Price |
$108.55
|
| Rate for Payer: Cash Price |
$102.70
|
| Rate for Payer: Health Management Network Commercial |
$141.95
|
| Rate for Payer: Health Management Network Commercial |
$134.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.20
|
| Rate for Payer: MDX Hawaii PPO |
$161.99
|
| Rate for Payer: MDX Hawaii PPO |
$153.26
|
|
|
DUP SCAN ABD PELV SCROT LIM
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
424939760
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$410.34
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$898.84
|
| Rate for Payer: Devoted Health Medicare |
$410.34
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$106.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$410.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.34
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.34
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
DUP SCAN ABD PELV SCROT LIM
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
424939760
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
DUP SCAN ART INFLOW OUTFLOW
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
424939750
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
DUP SCAN ART INFLOW OUTFLOW
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
424939750
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$185.92 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$410.34
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$898.84
|
| Rate for Payer: Devoted Health Medicare |
$410.34
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$185.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$410.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.34
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.34
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
DUP SCAN EXTRACRNL ART COMP BIL
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
424938800
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$410.34
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$898.84
|
| Rate for Payer: Devoted Health Medicare |
$410.34
|
| 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 Medicare |
$410.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$410.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.34
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.34
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
DUP SCAN EXTRACRNL ART COMP BIL
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
424938800
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
DUP SCAN EXT VEIN COMP
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
424939700
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$139.85 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$410.34
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$898.84
|
| Rate for Payer: Devoted Health Medicare |
$410.34
|
| 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 |
$410.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$410.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.34
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$139.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.34
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
DUP SCAN EXT VEIN COMP
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
424939700
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
|
|
DUP SCAN EXT VEIN LIM
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
424939710
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: AlohaCare Medicaid |
$344.50
|
| Rate for Payer: AlohaCare Medicare |
$289.38
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$633.88
|
| Rate for Payer: Devoted Health Medicare |
$289.38
|
| 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 |
$289.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$654.55
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Humana Medicare |
$289.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$351.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$289.38
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.38
|
| Rate for Payer: University Health Alliance Commercial |
$502.21
|
|
|
DUP SCAN EXT VEIN LIM
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
424939710
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
|
|
DUP SCAN LOWER EXT ART COMP
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
424939250
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$352.34 |
| Rate for Payer: AlohaCare Medicaid |
$180.50
|
| Rate for Payer: AlohaCare Medicaid |
$488.50
|
| Rate for Payer: AlohaCare Medicare |
$410.34
|
| Rate for Payer: AlohaCare Medicare |
$151.62
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$332.12
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$898.84
|
| Rate for Payer: Devoted Health Medicare |
$410.34
|
| Rate for Payer: Devoted Health Medicare |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$173.10
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$173.10
|
| 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 |
$151.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.34
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$928.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$342.95
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Humana Medicare |
$410.34
|
| Rate for Payer: Humana Medicare |
$151.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$498.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$184.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.62
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$151.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$151.62
|
| Rate for Payer: University Health Alliance Commercial |
$263.13
|
| Rate for Payer: University Health Alliance Commercial |
$712.14
|
|
|
DUP SCAN LOWER EXT ART COMP
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
424939250
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$830.45 |
| Max. Negotiated Rate |
$947.69 |
| Rate for Payer: Cash Price |
$635.05
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Health Management Network Commercial |
$830.45
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$879.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$324.90
|
| Rate for Payer: MDX Hawaii PPO |
$947.69
|
| Rate for Payer: MDX Hawaii PPO |
$350.17
|
|
|
DUP SCAN LOWER EXT ART LIM
|
Facility
|
OP
|
$689.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
424939260
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$103.46 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: AlohaCare Medicaid |
$344.50
|
| Rate for Payer: AlohaCare Medicare |
$289.38
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$633.88
|
| Rate for Payer: Devoted Health Medicare |
$289.38
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$103.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$654.55
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Humana Medicare |
$289.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$351.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$289.38
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.38
|
| Rate for Payer: University Health Alliance Commercial |
$502.21
|
|
|
DUP SCAN LOWER EXT ART LIM
|
Facility
|
IP
|
$689.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
424939260
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$668.33 |
| Rate for Payer: Cash Price |
$447.85
|
| Rate for Payer: Health Management Network Commercial |
$585.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$620.10
|
| Rate for Payer: MDX Hawaii PPO |
$668.33
|
|
|
dutasteride 0.5 mg Cap [KMC]
|
Facility
|
IP
|
$24.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Cash Price |
$15.73
|
| Rate for Payer: Health Management Network Commercial |
$20.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.78
|
| Rate for Payer: MDX Hawaii PPO |
$23.47
|
|
|
dutasteride 0.5 mg Cap [KMC]
|
Facility
|
OP
|
$24.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: AlohaCare Medicaid |
$12.10
|
| Rate for Payer: AlohaCare Medicare |
$10.16
|
| Rate for Payer: Cash Price |
$15.73
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$22.26
|
| Rate for Payer: Devoted Health Medicare |
$10.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.99
|
| Rate for Payer: Health Management Network Commercial |
$20.57
|
| Rate for Payer: Humana Medicare |
$10.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.16
|
| Rate for Payer: MDX Hawaii PPO |
$23.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.16
|
| Rate for Payer: University Health Alliance Commercial |
$17.64
|
|
|
DX RAD UPR EXTRM INFNT MIN 2 VWS
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
424730920
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$493.85 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Health Management Network Commercial |
$493.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.90
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
|
|
DX RAD UPR EXTRM INFNT MIN 2 VWS
|
Facility
|
OP
|
$581.00
|
|
|
Service Code
|
HCPCS 73092
|
| Hospital Charge Code |
424730920
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$563.57 |
| Rate for Payer: AlohaCare Medicaid |
$290.50
|
| Rate for Payer: AlohaCare Medicare |
$244.02
|
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Cash Price |
$377.65
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$534.52
|
| Rate for Payer: Devoted Health Medicare |
$244.02
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$16.41
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$244.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$493.85
|
| Rate for Payer: Humana Medicare |
$244.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$522.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$296.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$244.02
|
| Rate for Payer: MDX Hawaii PPO |
$563.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$244.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$244.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$244.02
|
| Rate for Payer: University Health Alliance Commercial |
$56.28
|
|
|
DYSEQUILIBRIUM
|
Facility
|
IP
|
$12,727.97
|
|
|
Service Code
|
MSDRG 149
|
| Min. Negotiated Rate |
$12,727.97 |
| Max. Negotiated Rate |
$12,727.97 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,727.97
|
|
