|
76882 US Up Extrem Non Vasc Ltd RT
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
8280919
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$729.30 |
| Max. Negotiated Rate |
$832.26 |
| Rate for Payer: Cash Price |
$557.70
|
| Rate for Payer: Health Management Network Commercial |
$729.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$772.20
|
| Rate for Payer: MDX Hawaii PPO |
$832.26
|
|
|
76882 US XTR NON-VASC LMTD
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
9902276
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$40.96
|
| Rate for Payer: AlohaCare Medicare |
$68.92
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$75.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
|
|
76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access si
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
8040548
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$437.75 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
|
|
76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access si
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
8040548
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: AlohaCare Medicaid |
$257.50
|
| Rate for Payer: AlohaCare Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Devoted Health Medicare |
$283.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$489.25
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Humana Medicare |
$257.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$262.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.50
|
| Rate for Payer: University Health Alliance Commercial |
$69.04
|
|
|
76937 US Guide Vascular Access
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
8280908
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$522.75 |
| Max. Negotiated Rate |
$596.55 |
| Rate for Payer: Cash Price |
$399.75
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.50
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
|
|
76937 US Guide Vascular Access
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
8280908
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$596.55 |
| Rate for Payer: AlohaCare Medicaid |
$307.50
|
| Rate for Payer: AlohaCare Medicare |
$307.50
|
| Rate for Payer: Cash Price |
$399.75
|
| Rate for Payer: Cash Price |
$399.75
|
| Rate for Payer: Devoted Health Medicare |
$338.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$584.25
|
| Rate for Payer: Health Management Network Commercial |
$522.75
|
| Rate for Payer: Humana Medicare |
$307.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$553.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$313.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$307.50
|
| Rate for Payer: MDX Hawaii PPO |
$596.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.50
|
| Rate for Payer: University Health Alliance Commercial |
$69.04
|
|
|
76942 U/S GUIDANCE FOR NEEDLE PLACEMENT, IMAGING SUPERVISION & INTERPRETATION
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
10769191
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$37.47
|
| Rate for Payer: AlohaCare Medicare |
$69.20
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Cash Price |
$77.35
|
| Rate for Payer: Devoted Health Medicare |
$76.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.35
|
| Rate for Payer: Health Management Network Commercial |
$101.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
76942 US Guidance Ndl Placement
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
8280909
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$560.15 |
| Max. Negotiated Rate |
$639.23 |
| Rate for Payer: Cash Price |
$428.35
|
| Rate for Payer: Health Management Network Commercial |
$560.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$593.10
|
| Rate for Payer: MDX Hawaii PPO |
$639.23
|
|
|
76942 US Guidance Ndl Placement
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
8280909
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$639.23 |
| Rate for Payer: AlohaCare Medicaid |
$329.50
|
| Rate for Payer: AlohaCare Medicare |
$329.50
|
| Rate for Payer: Cash Price |
$428.35
|
| Rate for Payer: Cash Price |
$428.35
|
| Rate for Payer: Devoted Health Medicare |
$362.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$329.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$104.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$626.05
|
| Rate for Payer: Health Management Network Commercial |
$560.15
|
| Rate for Payer: Humana Medicare |
$329.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$593.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$336.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$329.50
|
| Rate for Payer: MDX Hawaii PPO |
$639.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$329.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$329.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$329.50
|
| Rate for Payer: University Health Alliance Commercial |
$361.51
|
|
|
76942 US GUIDED NEEDLE PLACMENT ProFee
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
8022171
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$104.35 |
| Rate for Payer: AlohaCare Medicaid |
$37.47
|
| Rate for Payer: AlohaCare Medicare |
$69.20
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Devoted Health Medicare |
$76.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.35
|
| Rate for Payer: Health Management Network Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.20
|
|
|
77001 FLUOR GID CTR VAD PLMT RPLCMT/RMVL ProFee
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 77001 26
|
| Hospital Charge Code |
8103016
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$17.69
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Devoted Health Medicare |
$19.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$303.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$209.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$237.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$209.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
77001 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT ProFee
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
8523147
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: AlohaCare Medicaid |
$66.21
|
| Rate for Payer: AlohaCare Medicare |
$109.41
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Cash Price |
$139.75
|
| Rate for Payer: Devoted Health Medicare |
$120.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$109.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.19
|
| Rate for Payer: Health Management Network Commercial |
$182.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$109.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$109.41
|
|
|
77003 FLUOR GID & LOCLZJ NDL/CATH SPI DX/THER NJX ProFee
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 77003 26
|
| Hospital Charge Code |
8103018
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: AlohaCare Medicaid |
$70.14
|
| Rate for Payer: AlohaCare Medicare |
$28.83
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$31.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.55
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.83
|
|
|
77061 MG Mammo Diagnostic Left w/ Tomo Pro
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 77061 26,LT
|
| Hospital Charge Code |
11858274
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$206.71 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.71
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
|
|
77061 MG Mammo Diagnostic Left w/ Tomo. Pro
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 77061 LT
|
| Hospital Charge Code |
12125585
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$206.71 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.71
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
|
|
77061 MG Mammo Diagnostic Left w/ Tomo Tech
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 LT
|
| Hospital Charge Code |
11848525
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: AlohaCare Medicaid |
$175.50
|
| Rate for Payer: AlohaCare Medicare |
$175.50
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Devoted Health Medicare |
$193.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Humana Medicare |
$175.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.50
|
|
|
77061 MG Mammo Diagnostic Left w/ Tomo Tech
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 LT
|
| Hospital Charge Code |
11848525
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
|
|
77061 MG Mammo Diagnostic Left w/ Tomo. Tech
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 LT
|
| Hospital Charge Code |
12133861
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
|
|
77061 MG Mammo Diagnostic Left w/ Tomo. Tech
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 LT
|
| Hospital Charge Code |
12133861
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: AlohaCare Medicaid |
$175.50
|
| Rate for Payer: AlohaCare Medicare |
$175.50
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Devoted Health Medicare |
$193.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Humana Medicare |
$175.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.50
|
|
|
77061 MG Mammo Diagnostic Right w/ Tomo Pro
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 77061 RT
|
| Hospital Charge Code |
11858275
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$206.71 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.71
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
|
|
77061 MG Mammo Diagnostic Right w/ Tomo. Pro
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 77061 RT
|
| Hospital Charge Code |
12125586
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$206.71 |
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Cash Price |
$44.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.71
|
| Rate for Payer: Health Management Network Commercial |
$57.80
|
|
|
77061 MG Mammo Diagnostic Right w/ Tomo Tech
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 RT
|
| Hospital Charge Code |
11848526
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
|
|
77061 MG Mammo Diagnostic Right w/ Tomo Tech
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 RT
|
| Hospital Charge Code |
11848526
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: AlohaCare Medicaid |
$175.50
|
| Rate for Payer: AlohaCare Medicare |
$175.50
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Devoted Health Medicare |
$193.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Humana Medicare |
$175.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.50
|
|
|
77061 MG Mammo Diagnostic Right w/ Tomo. Tech
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 RT
|
| Hospital Charge Code |
12135853
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
|
|
77061 MG Mammo Diagnostic Right w/ Tomo. Tech
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 77061 RT
|
| Hospital Charge Code |
12135853
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$340.47 |
| Rate for Payer: AlohaCare Medicaid |
$175.50
|
| Rate for Payer: AlohaCare Medicare |
$175.50
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Devoted Health Medicare |
$193.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.45
|
| Rate for Payer: Health Management Network Commercial |
$298.35
|
| Rate for Payer: Humana Medicare |
$175.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.50
|
| Rate for Payer: MDX Hawaii PPO |
$340.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.50
|
|
