|
US Thoracentesis - Report
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
661687
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$742.05 |
| Rate for Payer: AlohaCare Medicaid |
$106.83
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.83
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$182.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.83
|
| Rate for Payer: Health Management Network Commercial |
$742.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$132.55
|
|
|
US Thyroid Biopsy
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 60100
|
| Hospital Charge Code |
8211782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$982.60 |
| Max. Negotiated Rate |
$1,121.32 |
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,040.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,121.32
|
|
|
US Thyroid Biopsy
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 60100
|
| Hospital Charge Code |
8211782
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$578.00
|
| Rate for Payer: AlohaCare Medicare |
$578.00
|
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Cash Price |
$751.40
|
| Rate for Payer: Devoted Health Medicare |
$635.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$578.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Health Management Network Commercial |
$982.60
|
| Rate for Payer: Humana Medicare |
$578.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,040.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$578.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,121.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$578.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$578.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$578.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
US Thyroid Biopsy - Report
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 60100
|
| Hospital Charge Code |
8211784
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$838.10 |
| Rate for Payer: AlohaCare Medicaid |
$75.37
|
| Rate for Payer: AlohaCare Medicare |
$64.31
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Devoted Health Medicare |
$70.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.37
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$92.82
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$75.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.31
|
| Rate for Payer: University Health Alliance Commercial |
$93.26
|
|
|
US Transcranial Doppler Complete
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
1169885
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$1,344.42 |
| Rate for Payer: AlohaCare Medicaid |
$693.00
|
| Rate for Payer: AlohaCare Medicare |
$693.00
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Devoted Health Medicare |
$762.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$168.52
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$693.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$201.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,316.70
|
| Rate for Payer: Health Management Network Commercial |
$1,178.10
|
| Rate for Payer: Humana Medicare |
$693.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$706.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$693.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,344.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$693.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$693.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$693.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,010.26
|
|
|
US Transcranial Doppler Complete
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
1169885
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,178.10 |
| Max. Negotiated Rate |
$1,344.42 |
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Health Management Network Commercial |
$1,178.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,344.42
|
|
|
US Transcranial Doppler Limited
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
7822548
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$106.46 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.46
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$111.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$516.06
|
|
|
US Transcranial Doppler Limited
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
7822548
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
1169889
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$230.73
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
1169889
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US Transvaginal Non-OB - Report
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 76830 26
|
| Hospital Charge Code |
630829
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: AlohaCare Medicaid |
$79.51
|
| Rate for Payer: AlohaCare Medicare |
$33.03
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$36.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.03
|
|
|
US Upper Ext Arterial Duplex Bilateral
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
HCPCS 93930
|
| Hospital Charge Code |
1169895
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,178.10 |
| Max. Negotiated Rate |
$1,344.42 |
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Health Management Network Commercial |
$1,178.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.40
|
| Rate for Payer: MDX Hawaii PPO |
$1,344.42
|
|
|
US Upper Ext Arterial Duplex Bilateral
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
HCPCS 93930
|
| Hospital Charge Code |
1169895
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$138.35 |
| Max. Negotiated Rate |
$1,344.42 |
| Rate for Payer: AlohaCare Medicaid |
$693.00
|
| Rate for Payer: AlohaCare Medicare |
$693.00
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Devoted Health Medicare |
$762.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$138.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$693.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$165.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,316.70
|
| Rate for Payer: Health Management Network Commercial |
$1,178.10
|
| Rate for Payer: Humana Medicare |
$693.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,247.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$706.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$693.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,344.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$693.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$693.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$693.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,010.26
|
|
|
US Upper Ext Arterial Duplex Bilateral - Report
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 93930 26
|
| Hospital Charge Code |
630818
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$221.07
|
| Rate for Payer: AlohaCare Medicare |
$37.28
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$41.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.23
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$221.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$221.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.28
|
|
|
US Upper Ext Arterial Duplex Left
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 93931 LT
|
| Hospital Charge Code |
1169897
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
US Upper Ext Arterial Duplex Left
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 93931 LT
|
| Hospital Charge Code |
1169897
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.01 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$107.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$516.06
|
|
|
US Upper Ext Arterial Duplex Left - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 93931 26,LT
|
| Hospital Charge Code |
630814
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$138.05 |
| Rate for Payer: AlohaCare Medicaid |
$138.05
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.55
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.05
|
|
|
US Upper Ext Arterial Duplex Right
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 93931 RT
|
| Hospital Charge Code |
1169899
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
US Upper Ext Arterial Duplex Right
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 93931 RT
|
| Hospital Charge Code |
1169899
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.01 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$90.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$107.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$672.60
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$516.06
|
|
|
US Upper Ext Arterial Duplex Right - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 93931 26,RT
|
| Hospital Charge Code |
630810
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$138.05 |
| Rate for Payer: AlohaCare Medicaid |
$138.05
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.55
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$138.05
|
|
|
US Upper Extrem Non Vasc Comp LT POC
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
10239195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US Upper Extrem Non Vasc Comp LT POC
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
10239195
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$246.33
|
|
|
US Upper Extrem Non Vasc Comp RT POC
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
10239196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US Upper Extrem Non Vasc Comp RT POC
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
10239196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$61.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$246.33
|
|
|
US Upper Extrem Non Vasc LT POC
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
10234951
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$10.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$60.62
|
|
