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Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $883.50
Max. Negotiated Rate $2,764.50
Rate for Payer: AlohaCare Medicaid $1,425.00
Rate for Payer: AlohaCare Medicare $883.50
Rate for Payer: Cash Price $1,710.00
Rate for Payer: Devoted Health Medicare $969.00
Rate for Payer: Hawaii Medical Service Association Medicare $883.50
Rate for Payer: Hawaii Western Management Group Commercial $1,995.00
Rate for Payer: Health Management Network Commercial $2,422.50
Rate for Payer: Humana Medicare $883.50
Rate for Payer: Kaiser Permanente Commercial $2,565.00
Rate for Payer: Kaiser Permanente Medicaid $1,453.50
Rate for Payer: Kaiser Permanente Medicare $883.50
Rate for Payer: MDX Hawaii PPO $2,764.50
Rate for Payer: Ohana Health Plan Medicaid $883.50
Rate for Payer: Ohana Health Plan Medicare $883.50
Rate for Payer: UnitedHealthcare Medicare $883.50
Rate for Payer: University Health Alliance Commercial $1,596.00
Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $98.00
Max. Negotiated Rate $169.75
Rate for Payer: Cash Price $105.00
Rate for Payer: Hawaii Western Management Group Commercial $122.50
Rate for Payer: Health Management Network Commercial $148.75
Rate for Payer: Kaiser Permanente Commercial $157.50
Rate for Payer: MDX Hawaii PPO $169.75
Rate for Payer: University Health Alliance Commercial $98.00
Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $54.25
Max. Negotiated Rate $169.75
Rate for Payer: AlohaCare Medicaid $87.50
Rate for Payer: AlohaCare Medicare $54.25
Rate for Payer: Cash Price $105.00
Rate for Payer: Devoted Health Medicare $59.50
Rate for Payer: Hawaii Medical Service Association Medicare $54.25
Rate for Payer: Hawaii Western Management Group Commercial $122.50
Rate for Payer: Health Management Network Commercial $148.75
Rate for Payer: Humana Medicare $54.25
Rate for Payer: Kaiser Permanente Commercial $157.50
Rate for Payer: Kaiser Permanente Medicaid $89.25
Rate for Payer: Kaiser Permanente Medicare $54.25
Rate for Payer: MDX Hawaii PPO $169.75
Rate for Payer: Ohana Health Plan Medicaid $54.25
Rate for Payer: Ohana Health Plan Medicare $54.25
Rate for Payer: UnitedHealthcare Medicare $54.25
Rate for Payer: University Health Alliance Commercial $98.00
Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $472.64
Max. Negotiated Rate $818.68
Rate for Payer: Cash Price $506.40
Rate for Payer: Hawaii Western Management Group Commercial $590.80
Rate for Payer: Health Management Network Commercial $717.40
Rate for Payer: Kaiser Permanente Commercial $759.60
Rate for Payer: MDX Hawaii PPO $818.68
Rate for Payer: University Health Alliance Commercial $472.64
Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $261.64
Max. Negotiated Rate $818.68
Rate for Payer: AlohaCare Medicaid $422.00
Rate for Payer: AlohaCare Medicare $261.64
Rate for Payer: Cash Price $506.40
Rate for Payer: Devoted Health Medicare $286.96
Rate for Payer: Hawaii Medical Service Association Medicare $261.64
Rate for Payer: Hawaii Western Management Group Commercial $590.80
Rate for Payer: Health Management Network Commercial $717.40
Rate for Payer: Humana Medicare $261.64
Rate for Payer: Kaiser Permanente Commercial $759.60
Rate for Payer: Kaiser Permanente Medicaid $430.44
Rate for Payer: Kaiser Permanente Medicare $261.64
Rate for Payer: MDX Hawaii PPO $818.68
Rate for Payer: Ohana Health Plan Medicaid $261.64
Rate for Payer: Ohana Health Plan Medicare $261.64
Rate for Payer: UnitedHealthcare Medicare $261.64
Rate for Payer: University Health Alliance Commercial $472.64
Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $1,162.50
Max. Negotiated Rate $3,637.50
Rate for Payer: AlohaCare Medicaid $1,875.00
Rate for Payer: AlohaCare Medicare $1,162.50
Rate for Payer: Cash Price $2,250.00
Rate for Payer: Devoted Health Medicare $1,275.00
Rate for Payer: Hawaii Medical Service Association Medicare $1,162.50
Rate for Payer: Hawaii Western Management Group Commercial $2,625.00
Rate for Payer: Health Management Network Commercial $3,187.50
Rate for Payer: Humana Medicare $1,162.50
Rate for Payer: Kaiser Permanente Commercial $3,375.00
Rate for Payer: Kaiser Permanente Medicaid $1,912.50
Rate for Payer: Kaiser Permanente Medicare $1,162.50
Rate for Payer: MDX Hawaii PPO $3,637.50
Rate for Payer: Ohana Health Plan Medicaid $1,162.50
Rate for Payer: Ohana Health Plan Medicare $1,162.50
Rate for Payer: UnitedHealthcare Medicare $1,162.50
Rate for Payer: University Health Alliance Commercial $2,100.00
Service Code HCPCS C1789
Hospital Revenue Code 278
Min. Negotiated Rate $2,100.00
Max. Negotiated Rate $3,637.50
Rate for Payer: Cash Price $2,250.00
Rate for Payer: Hawaii Western Management Group Commercial $2,625.00
Rate for Payer: Health Management Network Commercial $3,187.50
Rate for Payer: Kaiser Permanente Commercial $3,375.00
Rate for Payer: MDX Hawaii PPO $3,637.50
Rate for Payer: University Health Alliance Commercial $2,100.00
Service Code HCPCS J9042
Hospital Revenue Code 636
Min. Negotiated Rate $258.52
Max. Negotiated Rate $15,239.67
Rate for Payer: AlohaCare Medicaid $7,855.50
Rate for Payer: AlohaCare Medicare $4,870.41
Rate for Payer: Cash Price $9,426.60
Rate for Payer: Cash Price $9,426.60
Rate for Payer: Devoted Health Medicare $5,341.74
Rate for Payer: Hawaii Medical Service Association ABD $258.52
Rate for Payer: Hawaii Medical Service Association Commercial $335.91
Rate for Payer: Hawaii Medical Service Association Medicare $4,870.41
Rate for Payer: Hawaii Medical Service Association Non-ABD $258.52
Rate for Payer: Hawaii Western Management Group Commercial $14,925.45
Rate for Payer: Health Management Network Commercial $13,354.35
Rate for Payer: Humana Medicare $4,870.41
Rate for Payer: Kaiser Permanente Commercial $14,139.90
Rate for Payer: Kaiser Permanente Medicaid $8,012.61
Rate for Payer: Kaiser Permanente Medicare $4,870.41
Rate for Payer: MDX Hawaii PPO $15,239.67
Rate for Payer: Ohana Health Plan Medicaid $4,870.41
Rate for Payer: Ohana Health Plan Medicare $4,870.41
Rate for Payer: UnitedHealthcare Medicaid $9,426.60
Rate for Payer: UnitedHealthcare Medicare $4,870.41
Rate for Payer: University Health Alliance Commercial $11,451.75
Service Code HCPCS J9042
Hospital Revenue Code 250
Min. Negotiated Rate $13,354.35
Max. Negotiated Rate $15,239.67
Rate for Payer: Cash Price $9,426.60
Rate for Payer: Health Management Network Commercial $13,354.35
Rate for Payer: Kaiser Permanente Commercial $14,139.90
Rate for Payer: MDX Hawaii PPO $15,239.67
Service Code HCPCS J9042
Hospital Revenue Code 636
Min. Negotiated Rate $258.52
Max. Negotiated Rate $15,239.67
Rate for Payer: AlohaCare Medicaid $7,855.50
Rate for Payer: AlohaCare Medicaid $8,099.00
Rate for Payer: AlohaCare Medicare $5,021.38
Rate for Payer: AlohaCare Medicare $4,870.41
Rate for Payer: Cash Price $9,718.80
Rate for Payer: Cash Price $9,426.60
Rate for Payer: Cash Price $9,718.80
Rate for Payer: Cash Price $9,426.60
Rate for Payer: Devoted Health Medicare $5,341.74
Rate for Payer: Devoted Health Medicare $5,507.32
Rate for Payer: Hawaii Medical Service Association ABD $258.52
Rate for Payer: Hawaii Medical Service Association ABD $258.52
Rate for Payer: Hawaii Medical Service Association Commercial $335.91
Rate for Payer: Hawaii Medical Service Association Commercial $335.91
Rate for Payer: Hawaii Medical Service Association Medicare $5,021.38
Rate for Payer: Hawaii Medical Service Association Medicare $4,870.41
Rate for Payer: Hawaii Medical Service Association Non-ABD $258.52
Rate for Payer: Hawaii Medical Service Association Non-ABD $258.52
Rate for Payer: Hawaii Western Management Group Commercial $14,925.45
Rate for Payer: Hawaii Western Management Group Commercial $15,388.10
Rate for Payer: Health Management Network Commercial $13,768.30
Rate for Payer: Health Management Network Commercial $13,354.35
Rate for Payer: Humana Medicare $4,870.41
Rate for Payer: Humana Medicare $5,021.38
Rate for Payer: Kaiser Permanente Commercial $14,139.90
Rate for Payer: Kaiser Permanente Commercial $14,578.20
Rate for Payer: Kaiser Permanente Medicaid $8,260.98
Rate for Payer: Kaiser Permanente Medicaid $8,012.61
Rate for Payer: Kaiser Permanente Medicare $4,870.41
Rate for Payer: Kaiser Permanente Medicare $5,021.38
Rate for Payer: MDX Hawaii PPO $15,239.67
Rate for Payer: MDX Hawaii PPO $15,712.06
Rate for Payer: Ohana Health Plan Medicaid $5,021.38
Rate for Payer: Ohana Health Plan Medicaid $4,870.41
Rate for Payer: Ohana Health Plan Medicare $4,870.41
Rate for Payer: Ohana Health Plan Medicare $5,021.38
Rate for Payer: UnitedHealthcare Medicaid $9,718.80
Rate for Payer: UnitedHealthcare Medicaid $9,426.60
Rate for Payer: UnitedHealthcare Medicare $4,870.41
Rate for Payer: UnitedHealthcare Medicare $5,021.38
Rate for Payer: University Health Alliance Commercial $11,451.75
Rate for Payer: University Health Alliance Commercial $11,806.72
Service Code HCPCS J9042
Hospital Revenue Code 250
Min. Negotiated Rate $13,354.35
Max. Negotiated Rate $15,239.67
Rate for Payer: Cash Price $9,426.60
Rate for Payer: Cash Price $9,718.80
Rate for Payer: Health Management Network Commercial $13,354.35
Rate for Payer: Health Management Network Commercial $13,768.30
Rate for Payer: Kaiser Permanente Commercial $14,139.90
Rate for Payer: Kaiser Permanente Commercial $14,578.20
Rate for Payer: MDX Hawaii PPO $15,712.06
Rate for Payer: MDX Hawaii PPO $15,239.67
Service Code HCPCS C1713
Hospital Revenue Code 278
Min. Negotiated Rate $2,083.20
Max. Negotiated Rate $3,608.40
Rate for Payer: Cash Price $2,232.00
Rate for Payer: Hawaii Western Management Group Commercial $2,604.00
Rate for Payer: Health Management Network Commercial $3,162.00
Rate for Payer: Kaiser Permanente Commercial $3,348.00
Rate for Payer: MDX Hawaii PPO $3,608.40
Rate for Payer: University Health Alliance Commercial $2,083.20
Service Code HCPCS C1713
Hospital Revenue Code 278
Min. Negotiated Rate $1,153.20
Max. Negotiated Rate $3,608.40
Rate for Payer: AlohaCare Medicaid $1,860.00
Rate for Payer: AlohaCare Medicare $1,153.20
Rate for Payer: Cash Price $2,232.00
Rate for Payer: Devoted Health Medicare $1,264.80
Rate for Payer: Hawaii Medical Service Association Medicare $1,153.20
Rate for Payer: Hawaii Western Management Group Commercial $2,604.00
Rate for Payer: Health Management Network Commercial $3,162.00
Rate for Payer: Humana Medicare $1,153.20
Rate for Payer: Kaiser Permanente Commercial $3,348.00
Rate for Payer: Kaiser Permanente Medicaid $1,897.20
Rate for Payer: Kaiser Permanente Medicare $1,153.20
Rate for Payer: MDX Hawaii PPO $3,608.40
Rate for Payer: Ohana Health Plan Medicaid $1,153.20
Rate for Payer: Ohana Health Plan Medicare $1,153.20
Rate for Payer: UnitedHealthcare Medicare $1,153.20
Rate for Payer: University Health Alliance Commercial $2,083.20
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $459.00
Max. Negotiated Rate $523.80
Rate for Payer: Cash Price $324.00
Rate for Payer: Health Management Network Commercial $459.00
Rate for Payer: Kaiser Permanente Commercial $486.00
Rate for Payer: MDX Hawaii PPO $523.80
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $167.40
Max. Negotiated Rate $523.80
Rate for Payer: AlohaCare Medicaid $270.00
Rate for Payer: AlohaCare Medicare $167.40
Rate for Payer: Cash Price $324.00
Rate for Payer: Devoted Health Medicare $183.60
Rate for Payer: Hawaii Medical Service Association Medicare $167.40
Rate for Payer: Hawaii Western Management Group Commercial $513.00
Rate for Payer: Health Management Network Commercial $459.00
Rate for Payer: Humana Medicare $167.40
Rate for Payer: Kaiser Permanente Commercial $486.00
Rate for Payer: Kaiser Permanente Medicaid $275.40
Rate for Payer: Kaiser Permanente Medicare $167.40
Rate for Payer: MDX Hawaii PPO $523.80
Rate for Payer: Ohana Health Plan Medicaid $167.40
Rate for Payer: Ohana Health Plan Medicare $167.40
Rate for Payer: UnitedHealthcare Medicare $167.40
Rate for Payer: University Health Alliance Commercial $393.61
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $187.24
Max. Negotiated Rate $585.88
Rate for Payer: AlohaCare Medicaid $302.00
Rate for Payer: AlohaCare Medicare $187.24
Rate for Payer: Cash Price $362.40
Rate for Payer: Devoted Health Medicare $205.36
Rate for Payer: Hawaii Medical Service Association Medicare $187.24
Rate for Payer: Hawaii Western Management Group Commercial $573.80
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Humana Medicare $187.24
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: Kaiser Permanente Medicaid $308.04
Rate for Payer: Kaiser Permanente Medicare $187.24
Rate for Payer: MDX Hawaii PPO $585.88
Rate for Payer: Ohana Health Plan Medicaid $187.24
Rate for Payer: Ohana Health Plan Medicare $187.24
Rate for Payer: UnitedHealthcare Medicare $187.24
Rate for Payer: University Health Alliance Commercial $440.26
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $513.40
Max. Negotiated Rate $585.88
Rate for Payer: Cash Price $362.40
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: MDX Hawaii PPO $585.88
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $187.24
Max. Negotiated Rate $585.88
Rate for Payer: AlohaCare Medicaid $302.00
Rate for Payer: AlohaCare Medicare $187.24
Rate for Payer: Cash Price $362.40
Rate for Payer: Devoted Health Medicare $205.36
Rate for Payer: Hawaii Medical Service Association Medicare $187.24
Rate for Payer: Hawaii Western Management Group Commercial $573.80
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Humana Medicare $187.24
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: Kaiser Permanente Medicaid $308.04
Rate for Payer: Kaiser Permanente Medicare $187.24
Rate for Payer: MDX Hawaii PPO $585.88
Rate for Payer: Ohana Health Plan Medicaid $187.24
Rate for Payer: Ohana Health Plan Medicare $187.24
Rate for Payer: UnitedHealthcare Medicare $187.24
Rate for Payer: University Health Alliance Commercial $440.26
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $513.40
Max. Negotiated Rate $585.88
Rate for Payer: Cash Price $362.40
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: MDX Hawaii PPO $585.88
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $43.40
Max. Negotiated Rate $135.80
Rate for Payer: AlohaCare Medicaid $70.00
Rate for Payer: AlohaCare Medicare $43.40
Rate for Payer: Cash Price $84.00
Rate for Payer: Devoted Health Medicare $47.60
Rate for Payer: Hawaii Medical Service Association Medicare $43.40
Rate for Payer: Hawaii Western Management Group Commercial $133.00
Rate for Payer: Health Management Network Commercial $119.00
Rate for Payer: Humana Medicare $43.40
Rate for Payer: Kaiser Permanente Commercial $126.00
Rate for Payer: Kaiser Permanente Medicaid $71.40
Rate for Payer: Kaiser Permanente Medicare $43.40
Rate for Payer: MDX Hawaii PPO $135.80
Rate for Payer: Ohana Health Plan Medicaid $43.40
Rate for Payer: Ohana Health Plan Medicare $43.40
Rate for Payer: UnitedHealthcare Medicare $43.40
Rate for Payer: University Health Alliance Commercial $102.05
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $119.00
Max. Negotiated Rate $135.80
Rate for Payer: Cash Price $84.00
Rate for Payer: Health Management Network Commercial $119.00
Rate for Payer: Kaiser Permanente Commercial $126.00
Rate for Payer: MDX Hawaii PPO $135.80
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $513.40
Max. Negotiated Rate $585.88
Rate for Payer: Cash Price $362.40
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: MDX Hawaii PPO $585.88
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $187.24
Max. Negotiated Rate $585.88
Rate for Payer: AlohaCare Medicaid $302.00
Rate for Payer: AlohaCare Medicare $187.24
Rate for Payer: Cash Price $362.40
Rate for Payer: Devoted Health Medicare $205.36
Rate for Payer: Hawaii Medical Service Association Medicare $187.24
Rate for Payer: Hawaii Western Management Group Commercial $573.80
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Humana Medicare $187.24
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: Kaiser Permanente Medicaid $308.04
Rate for Payer: Kaiser Permanente Medicare $187.24
Rate for Payer: MDX Hawaii PPO $585.88
Rate for Payer: Ohana Health Plan Medicaid $187.24
Rate for Payer: Ohana Health Plan Medicare $187.24
Rate for Payer: UnitedHealthcare Medicare $187.24
Rate for Payer: University Health Alliance Commercial $440.26
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $187.24
Max. Negotiated Rate $585.88
Rate for Payer: AlohaCare Medicaid $302.00
Rate for Payer: AlohaCare Medicare $187.24
Rate for Payer: Cash Price $362.40
Rate for Payer: Devoted Health Medicare $205.36
Rate for Payer: Hawaii Medical Service Association Medicare $187.24
Rate for Payer: Hawaii Western Management Group Commercial $573.80
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Humana Medicare $187.24
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: Kaiser Permanente Medicaid $308.04
Rate for Payer: Kaiser Permanente Medicare $187.24
Rate for Payer: MDX Hawaii PPO $585.88
Rate for Payer: Ohana Health Plan Medicaid $187.24
Rate for Payer: Ohana Health Plan Medicare $187.24
Rate for Payer: UnitedHealthcare Medicare $187.24
Rate for Payer: University Health Alliance Commercial $440.26
Service Code HCPCS C1894
Hospital Revenue Code 272
Min. Negotiated Rate $513.40
Max. Negotiated Rate $585.88
Rate for Payer: Cash Price $362.40
Rate for Payer: Health Management Network Commercial $513.40
Rate for Payer: Kaiser Permanente Commercial $543.60
Rate for Payer: MDX Hawaii PPO $585.88