|
93005 EKG Tracing Only Charge
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
8220760
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
|
|
93010 EKG w/ 12+ leads; Interp/Report Only
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 93010
|
| Hospital Charge Code |
8040644
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$52.70 |
| Rate for Payer: AlohaCare Medicaid |
$8.14
|
| Rate for Payer: AlohaCare Medicare |
$8.53
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Devoted Health Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.56
|
| Rate for Payer: Health Management Network Commercial |
$52.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.53
|
|
|
93015 Cardiovascular stress test, complete; with supervision, interpretation and report
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 93015
|
| Hospital Charge Code |
8040645
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$78.11 |
| Max. Negotiated Rate |
$238.85 |
| Rate for Payer: AlohaCare Medicaid |
$78.11
|
| Rate for Payer: AlohaCare Medicare |
$79.46
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: Devoted Health Medicare |
$87.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.19
|
| Rate for Payer: Health Management Network Commercial |
$238.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$78.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.46
|
|
|
93017 Cardiovascular Stress Test Charge
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
8220702
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$1,562.67 |
| Rate for Payer: AlohaCare Medicaid |
$805.50
|
| Rate for Payer: AlohaCare Medicare |
$805.50
|
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: Devoted Health Medicare |
$886.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$805.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,530.45
|
| Rate for Payer: Health Management Network Commercial |
$1,369.35
|
| Rate for Payer: Humana Medicare |
$805.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,449.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$821.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$805.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,562.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$805.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$805.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$805.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,174.26
|
|
|
93017 Cardiovascular Stress Test Charge
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
8220702
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$1,369.35 |
| Max. Negotiated Rate |
$1,562.67 |
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: Health Management Network Commercial |
$1,369.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,449.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,562.67
|
|
|
93018 Cardiovascular stress test; interpretation and report only
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93018
|
| Hospital Charge Code |
8040648
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: AlohaCare Medicaid |
$14.00
|
| Rate for Payer: AlohaCare Medicare |
$14.06
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Devoted Health Medicare |
$15.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.25
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.06
|
|
|
93041 Rhythm ECG, 1-3 leads; tracing only without interpretation and report
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
8040650
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: Cash Price |
$113.75
|
| 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
|
|
|
93041 Rhythm ECG, 1-3 leads; tracing only without interpretation and report
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
8040650
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$169.75 |
| Rate for Payer: AlohaCare Medicaid |
$87.50
|
| Rate for Payer: AlohaCare Medicare |
$87.50
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Cash Price |
$113.75
|
| Rate for Payer: Devoted Health Medicare |
$96.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$87.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$166.25
|
| Rate for Payer: Health Management Network Commercial |
$148.75
|
| Rate for Payer: Humana Medicare |
$87.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$157.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$89.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$87.50
|
| Rate for Payer: MDX Hawaii PPO |
$169.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$87.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$87.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$87.50
|
| Rate for Payer: University Health Alliance Commercial |
$127.56
|
|
|
93041 Rhythm ECG Tracing Charge
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
8220785
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: AlohaCare Medicaid |
$106.00
|
| Rate for Payer: AlohaCare Medicare |
$106.00
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Devoted Health Medicare |
$116.60
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.40
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Humana Medicare |
$106.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$108.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.00
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.00
|
| Rate for Payer: University Health Alliance Commercial |
$154.53
|
|
|
93041 Rhythm ECG Tracing Charge
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
8220785
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$205.64 |
| Rate for Payer: Cash Price |
$137.80
|
| Rate for Payer: Health Management Network Commercial |
$180.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$190.80
|
| Rate for Payer: MDX Hawaii PPO |
$205.64
|
|
|
93303 Echo Transthoracic Charge
|
Facility
|
IP
|
$2,795.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
8220549
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,375.75 |
| Max. Negotiated Rate |
$2,711.15 |
| Rate for Payer: Cash Price |
$1,816.75
|
| Rate for Payer: Health Management Network Commercial |
$2,375.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,515.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,711.15
|
|
|
93303 Echo Transthoracic Charge
|
Facility
|
OP
|
$2,795.00
|
|
|
Service Code
|
HCPCS 93303
|
| Hospital Charge Code |
8220549
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$2,711.15 |
| Rate for Payer: AlohaCare Medicaid |
$1,397.50
|
| Rate for Payer: AlohaCare Medicare |
$1,397.50
|
| Rate for Payer: Cash Price |
$1,816.75
|
| Rate for Payer: Cash Price |
$1,816.75
|
| Rate for Payer: Devoted Health Medicare |
$1,537.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,397.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,655.25
|
| Rate for Payer: Health Management Network Commercial |
$2,375.75
|
| Rate for Payer: Humana Medicare |
$1,397.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,515.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,425.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,397.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,711.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,397.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,397.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,397.50
|
| Rate for Payer: University Health Alliance Commercial |
$2,037.28
|
|
|
93307 Echo T-Thoracic 2D Compl Charge
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
8220581
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,232.50 |
| Max. Negotiated Rate |
$1,406.50 |
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
|
|
93307 Echo T-Thoracic 2D Compl Charge
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
8220581
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$1,406.50 |
| Rate for Payer: AlohaCare Medicaid |
$725.00
|
| Rate for Payer: AlohaCare Medicare |
$725.00
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Devoted Health Medicare |
$797.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$725.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,377.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Humana Medicare |
$725.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$739.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,056.90
|
|
|
93308 Echo TTE Follow Up or Limited 2D POC
|
Facility
|
IP
|
$1,442.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8280903
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,225.70 |
| Max. Negotiated Rate |
$1,398.74 |
| Rate for Payer: Cash Price |
$937.30
|
| Rate for Payer: Health Management Network Commercial |
$1,225.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,297.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,398.74
|
|
|
93308 Echo TTE Follow Up or Limited 2D POC
|
Facility
|
OP
|
$1,442.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8280903
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$64.51 |
| Max. Negotiated Rate |
$1,398.74 |
| Rate for Payer: AlohaCare Medicaid |
$721.00
|
| Rate for Payer: AlohaCare Medicare |
$721.00
|
| Rate for Payer: Cash Price |
$937.30
|
| Rate for Payer: Cash Price |
$937.30
|
| Rate for Payer: Devoted Health Medicare |
$793.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$721.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,369.90
|
| Rate for Payer: Health Management Network Commercial |
$1,225.70
|
| Rate for Payer: Humana Medicare |
$721.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,297.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$735.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$721.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,398.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$721.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$721.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$721.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,051.07
|
|
|
93308 TTE Follow Up or Limited Charge
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8220643
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$64.51 |
| Max. Negotiated Rate |
$1,495.74 |
| Rate for Payer: AlohaCare Medicaid |
$771.00
|
| Rate for Payer: AlohaCare Medicare |
$771.00
|
| Rate for Payer: Cash Price |
$1,002.30
|
| Rate for Payer: Cash Price |
$1,002.30
|
| Rate for Payer: Devoted Health Medicare |
$848.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$771.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,464.90
|
| Rate for Payer: Health Management Network Commercial |
$1,310.70
|
| Rate for Payer: Humana Medicare |
$771.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,387.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$786.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$771.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,495.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$771.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$771.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$771.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,123.96
|
|
|
93308 TTE Follow Up or Limited Charge
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8220643
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,310.70 |
| Max. Negotiated Rate |
$1,495.74 |
| Rate for Payer: Cash Price |
$1,002.30
|
| Rate for Payer: Health Management Network Commercial |
$1,310.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,387.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,495.74
|
|
|
93321 Doppler Echo Exam Heart Ltd Charge
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
8220489
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: AlohaCare Medicaid |
$219.50
|
| Rate for Payer: AlohaCare Medicare |
$219.50
|
| Rate for Payer: Cash Price |
$285.35
|
| Rate for Payer: Cash Price |
$285.35
|
| Rate for Payer: Devoted Health Medicare |
$241.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$37.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$219.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$39.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$417.05
|
| Rate for Payer: Health Management Network Commercial |
$373.15
|
| Rate for Payer: Humana Medicare |
$219.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$395.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$223.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$219.50
|
| Rate for Payer: MDX Hawaii PPO |
$425.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$219.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$219.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$219.50
|
| Rate for Payer: University Health Alliance Commercial |
$319.99
|
|
|
93321 Doppler Echo Exam Heart Ltd Charge
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
8220489
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$373.15 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Cash Price |
$285.35
|
| Rate for Payer: Health Management Network Commercial |
$373.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$395.10
|
| Rate for Payer: MDX Hawaii PPO |
$425.83
|
|
|
93350 Echo Stress Test Charge
|
Facility
|
IP
|
$2,145.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
8220519
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,823.25 |
| Max. Negotiated Rate |
$2,080.65 |
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Health Management Network Commercial |
$1,823.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,930.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,080.65
|
|
|
93350 Echo Stress Test Charge
|
Facility
|
OP
|
$2,145.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
8220519
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$2,080.65 |
| Rate for Payer: AlohaCare Medicaid |
$1,072.50
|
| Rate for Payer: AlohaCare Medicare |
$1,072.50
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Cash Price |
$1,394.25
|
| Rate for Payer: Devoted Health Medicare |
$1,179.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$58.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,072.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$61.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,037.75
|
| Rate for Payer: Health Management Network Commercial |
$1,823.25
|
| Rate for Payer: Humana Medicare |
$1,072.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,930.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,093.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,072.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,080.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,072.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,072.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,072.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,563.49
|
|
|
93503 Insert Place Heart Catheter Charge
|
Facility
|
OP
|
$8,118.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
8220819
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$7,874.46 |
| Rate for Payer: AlohaCare Medicaid |
$4,059.00
|
| Rate for Payer: AlohaCare Medicare |
$4,059.00
|
| Rate for Payer: Cash Price |
$5,276.70
|
| Rate for Payer: Cash Price |
$5,276.70
|
| Rate for Payer: Cash Price |
$5,276.70
|
| Rate for Payer: Devoted Health Medicare |
$4,464.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,010.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,059.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,712.10
|
| Rate for Payer: Health Management Network Commercial |
$6,900.30
|
| Rate for Payer: Humana Medicare |
$4,059.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,306.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,140.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,059.00
|
| Rate for Payer: MDX Hawaii PPO |
$7,874.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,059.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,059.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,059.00
|
| Rate for Payer: University Health Alliance Commercial |
$5,917.21
|
|
|
93503 Insert Place Heart Catheter Charge
|
Facility
|
IP
|
$8,118.00
|
|
|
Service Code
|
HCPCS 93503
|
| Hospital Charge Code |
8220819
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,900.30 |
| Max. Negotiated Rate |
$7,874.46 |
| Rate for Payer: Cash Price |
$5,276.70
|
| Rate for Payer: Health Management Network Commercial |
$6,900.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,306.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,874.46
|
|
|
93880 Duplex scan of extracranial arteries; complete bilateral study
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
8040726
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.42 |
| Max. Negotiated Rate |
$492.15 |
| Rate for Payer: AlohaCare Medicaid |
$212.08
|
| Rate for Payer: AlohaCare Medicare |
$209.52
|
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Devoted Health Medicare |
$230.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.42
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$230.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$230.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$230.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$209.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.52
|
|
