|
92950 CPR CODE BLUE CHARGE CHARGE
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8408953
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$168.25 |
| Max. Negotiated Rate |
$1,211.53 |
| Rate for Payer: AlohaCare Medicaid |
$624.50
|
| Rate for Payer: AlohaCare Medicare |
$624.50
|
| Rate for Payer: Cash Price |
$811.85
|
| Rate for Payer: Cash Price |
$811.85
|
| Rate for Payer: Devoted Health Medicare |
$686.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$275.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$624.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,186.55
|
| Rate for Payer: Health Management Network Commercial |
$1,061.65
|
| Rate for Payer: Humana Medicare |
$624.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,124.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$636.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$624.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,211.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$624.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$624.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$168.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$624.50
|
| Rate for Payer: University Health Alliance Commercial |
$699.44
|
|
|
92950 CPR CODE BLUE CHARGE CHARGE
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
8408953
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,061.65 |
| Max. Negotiated Rate |
$1,211.53 |
| Rate for Payer: Cash Price |
$811.85
|
| Rate for Payer: Health Management Network Commercial |
$1,061.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,124.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,211.53
|
|
|
92953 Temporary External Pacing TechFee
|
Facility
|
OP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8343985
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$745.50
|
| Rate for Payer: AlohaCare Medicare |
$745.50
|
| Rate for Payer: Cash Price |
$969.15
|
| Rate for Payer: Cash Price |
$969.15
|
| Rate for Payer: Devoted Health Medicare |
$820.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$745.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,416.45
|
| Rate for Payer: Health Management Network Commercial |
$1,267.35
|
| Rate for Payer: Humana Medicare |
$745.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,341.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$745.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,446.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$745.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$745.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$745.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,086.79
|
|
|
92953 Temporary External Pacing TechFee
|
Facility
|
IP
|
$1,491.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8343985
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,267.35 |
| Max. Negotiated Rate |
$1,446.27 |
| Rate for Payer: Cash Price |
$969.15
|
| Rate for Payer: Health Management Network Commercial |
$1,267.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,341.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,446.27
|
|
|
92953 Temporary transcutaneous pacing.
|
Facility
|
OP
|
$4,117.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8743020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$3,993.49 |
| Rate for Payer: AlohaCare Medicaid |
$2,058.50
|
| Rate for Payer: AlohaCare Medicare |
$2,058.50
|
| Rate for Payer: Cash Price |
$2,676.05
|
| Rate for Payer: Cash Price |
$2,676.05
|
| Rate for Payer: Devoted Health Medicare |
$2,264.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,058.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,911.15
|
| Rate for Payer: Health Management Network Commercial |
$3,499.45
|
| Rate for Payer: Humana Medicare |
$2,058.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,705.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,058.50
|
| Rate for Payer: MDX Hawaii PPO |
$3,993.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,058.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,058.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,058.50
|
| Rate for Payer: University Health Alliance Commercial |
$3,000.88
|
|
|
92953 Temporary transcutaneous pacing.
|
Facility
|
IP
|
$4,117.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8743020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,499.45 |
| Max. Negotiated Rate |
$3,993.49 |
| Rate for Payer: Cash Price |
$2,676.05
|
| Rate for Payer: Health Management Network Commercial |
$3,499.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,705.30
|
| Rate for Payer: MDX Hawaii PPO |
$3,993.49
|
|
|
92953 TEMP PACKMAKER - ER SERV PROCEDURE
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
8051095
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$0.90
|
| Rate for Payer: AlohaCare Medicare |
$0.91
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Devoted Health Medicare |
$1.00
|
| 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 |
$21.46
|
| Rate for Payer: Health Management Network Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.09
|
| 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 |
$0.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.91
|
| 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
|
|
|
92960 - Cardioversion; Elective
|
Facility
|
IP
|
$2,653.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8080175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,255.05 |
| Max. Negotiated Rate |
$2,573.41 |
| Rate for Payer: Cash Price |
$1,724.45
|
| Rate for Payer: Health Management Network Commercial |
$2,255.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,387.70
|
| Rate for Payer: MDX Hawaii PPO |
$2,573.41
|
|
|
92960 - Cardioversion; Elective
|
Facility
|
OP
|
$2,653.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8080175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,326.50
|
| Rate for Payer: AlohaCare Medicare |
$1,326.50
|
| Rate for Payer: Cash Price |
$1,724.45
|
| Rate for Payer: Cash Price |
$1,724.45
|
| Rate for Payer: Cash Price |
$1,724.45
|
| Rate for Payer: Devoted Health Medicare |
$1,459.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$844.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,326.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,520.35
|
| Rate for Payer: Health Management Network Commercial |
$2,255.05
|
| Rate for Payer: Humana Medicare |
$1,326.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,387.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,353.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,326.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,573.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,326.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,326.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,326.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee
|
Facility
|
IP
|
$3,166.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8211358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,691.10 |
| Max. Negotiated Rate |
$3,071.02 |
| Rate for Payer: Cash Price |
$2,057.90
|
| Rate for Payer: Health Management Network Commercial |
$2,691.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,849.40
|
| Rate for Payer: MDX Hawaii PPO |
$3,071.02
|
|
|
92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee
|
Facility
|
OP
|
$3,166.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8211358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$1,583.00
|
| Rate for Payer: AlohaCare Medicare |
$1,583.00
|
| Rate for Payer: Cash Price |
$2,057.90
|
| Rate for Payer: Cash Price |
$2,057.90
|
| Rate for Payer: Devoted Health Medicare |
$1,741.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,583.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3,007.70
|
| Rate for Payer: Health Management Network Commercial |
$2,691.10
|
| Rate for Payer: Humana Medicare |
$1,583.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,849.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,583.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,071.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,583.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,583.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,583.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
92960 CARDIOVERSION - ER SERV PROCEDURE
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8051096
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$881.45 |
| Rate for Payer: AlohaCare Medicaid |
$108.77
|
| Rate for Payer: AlohaCare Medicare |
$96.14
|
| Rate for Payer: Cash Price |
$674.05
|
| Rate for Payer: Cash Price |
$674.05
|
| Rate for Payer: Cash Price |
$674.05
|
| Rate for Payer: Devoted Health Medicare |
$105.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$209.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.64
|
| 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 Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.52
|
| Rate for Payer: Health Management Network Commercial |
$881.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.37
|
| 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 |
$246.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| 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: Ohana Health Plan Medicaid |
$108.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: University Health Alliance Commercial |
$135.15
|
|
|
92960 CARDIOVERSION - ER SERV PROCEDURE
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
8051096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$881.45 |
| Rate for Payer: AlohaCare Medicaid |
$108.77
|
| Rate for Payer: AlohaCare Medicare |
$96.14
|
| Rate for Payer: Cash Price |
$674.05
|
| Rate for Payer: Cash Price |
$674.05
|
| Rate for Payer: Devoted Health Medicare |
$105.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$108.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$96.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$108.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.52
|
| Rate for Payer: Health Management Network Commercial |
$881.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$115.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$115.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$96.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$108.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$96.14
|
| Rate for Payer: University Health Alliance Commercial |
$135.15
|
|
|
92973 Percutaneous transluminal coronary thrombectomy mechanical
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
8040637
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$442.85 |
| Rate for Payer: AlohaCare Medicaid |
$166.22
|
| Rate for Payer: AlohaCare Medicare |
$77.38
|
| Rate for Payer: Cash Price |
$338.65
|
| Rate for Payer: Cash Price |
$338.65
|
| Rate for Payer: Cash Price |
$338.65
|
| Rate for Payer: Devoted Health Medicare |
$85.12
|
| 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 |
$175.71
|
| Rate for Payer: Health Management Network Commercial |
$442.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.86
|
| 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 |
$166.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.38
|
| 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
|
|
|
92975 Thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
HCPCS 92975
|
| Hospital Charge Code |
8040638
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$940.95 |
| Rate for Payer: Cash Price |
$719.55
|
| Rate for Payer: Cash Price |
$719.55
|
| Rate for Payer: Cash Price |
$719.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| 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 |
$265.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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 |
$390.99
|
| Rate for Payer: Health Management Network Commercial |
$940.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| 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 |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| 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 |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| 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 |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92977 THROMBOLYSIS - ER SERV PROCEDURE
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 92977
|
| Hospital Charge Code |
8051097
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Cash Price |
$234.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$265.97
|
| 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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$259.84
|
| Rate for Payer: Health Management Network Commercial |
$306.85
|
| 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 Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| 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 |
$265.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$303.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| 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 |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
92978 Intravascular ultrasound; initial vessel
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
8040640
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$181.39 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$229.41
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$434.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.46
|
| 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 |
$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 Medicare |
$237.64
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$225.06
|
| Rate for Payer: Health Management Network Commercial |
$244.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$246.64
|
| 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 |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$303.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.26
|
| 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 |
$339.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$265.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$229.41
|
| 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
|
|
|
93000 EKG W/INTERP & REPORT
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
9390423
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$15.21
|
| Rate for Payer: AlohaCare Medicare |
$16.32
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Devoted Health Medicare |
$17.95
|
| 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 |
$30.55
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.58
|
| 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 |
$15.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.32
|
| 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
|
|
|
93005-ED EKG
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
8080242
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$358.90 |
| Rate for Payer: AlohaCare Medicaid |
$185.00
|
| Rate for Payer: AlohaCare Medicare |
$185.00
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Devoted Health Medicare |
$203.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$185.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$351.50
|
| Rate for Payer: Health Management Network Commercial |
$314.50
|
| Rate for Payer: Humana Medicare |
$185.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$188.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$185.00
|
| Rate for Payer: MDX Hawaii PPO |
$358.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$185.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$185.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$185.00
|
| Rate for Payer: University Health Alliance Commercial |
$207.20
|
|
|
93005-ED EKG
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
8080242
|
|
Hospital Revenue Code
|
732
|
| Min. Negotiated Rate |
$314.50 |
| Max. Negotiated Rate |
$358.90 |
| Rate for Payer: Cash Price |
$240.50
|
| Rate for Payer: Health Management Network Commercial |
$314.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.00
|
| Rate for Payer: MDX Hawaii PPO |
$358.90
|
|
|
93005 EKG Tracing Only Addl Charge
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 93005 76
|
| Hospital Charge Code |
8220605
|
|
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
|
|
|
93005 EKG Tracing Only Addl Charge
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 93005 76
|
| Hospital Charge Code |
8220605
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: AlohaCare Medicaid |
$200.00
|
| Rate for Payer: AlohaCare Medicare |
$200.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Devoted Health Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Humana Medicare |
$200.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.00
|
| Rate for Payer: University Health Alliance Commercial |
$224.00
|
|
|
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
|
|
|
93005 EKG Tracing Only Charge
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
8220760
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: AlohaCare Medicaid |
$200.00
|
| Rate for Payer: AlohaCare Medicare |
$200.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Devoted Health Medicare |
$220.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$75.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.00
|
| Rate for Payer: Health Management Network Commercial |
$340.00
|
| Rate for Payer: Humana Medicare |
$200.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.00
|
| Rate for Payer: MDX Hawaii PPO |
$388.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.00
|
| Rate for Payer: University Health Alliance Commercial |
$224.00
|
|
|
93005 EKG w/ 12+ leads; Tracing Only
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
8040643
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$7.07
|
| Rate for Payer: AlohaCare Medicare |
$7.79
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Devoted Health Medicare |
$8.57
|
| 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 |
$19.01
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.35
|
| 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 |
$7.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.79
|
| 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
|
|
