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Service Code HCPCS 86777
Hospital Charge Code 8404553
Hospital Revenue Code 302
Min. Negotiated Rate $14.39
Max. Negotiated Rate $160.05
Rate for Payer: AlohaCare Medicaid $82.50
Rate for Payer: AlohaCare Medicare $82.50
Rate for Payer: Cash Price $107.25
Rate for Payer: Cash Price $107.25
Rate for Payer: Devoted Health Medicare $90.75
Rate for Payer: Hawaii Medical Service Association ABD $19.89
Rate for Payer: Hawaii Medical Service Association Commercial $17.99
Rate for Payer: Hawaii Medical Service Association Medicare $82.50
Rate for Payer: Hawaii Medical Service Association Non-ABD $20.88
Rate for Payer: Hawaii Western Management Group Commercial $14.39
Rate for Payer: Health Management Network Commercial $140.25
Rate for Payer: Humana Medicare $82.50
Rate for Payer: Kaiser Permanente Commercial $148.50
Rate for Payer: Kaiser Permanente Medicaid $84.15
Rate for Payer: Kaiser Permanente Medicare $82.50
Rate for Payer: MDX Hawaii PPO $160.05
Rate for Payer: Ohana Health Plan Medicaid $82.50
Rate for Payer: Ohana Health Plan Medicare $82.50
Rate for Payer: UnitedHealthcare Medicaid $19.89
Rate for Payer: UnitedHealthcare Medicare $82.50
Rate for Payer: University Health Alliance Commercial $37.20
Service Code HCPCS 86777
Hospital Charge Code 8404553
Hospital Revenue Code 302
Min. Negotiated Rate $140.25
Max. Negotiated Rate $160.05
Rate for Payer: Cash Price $107.25
Rate for Payer: Health Management Network Commercial $140.25
Rate for Payer: Kaiser Permanente Commercial $148.50
Rate for Payer: MDX Hawaii PPO $160.05
Service Code HCPCS 86778
Hospital Charge Code 8404554
Hospital Revenue Code 302
Min. Negotiated Rate $14.41
Max. Negotiated Rate $160.05
Rate for Payer: AlohaCare Medicaid $82.50
Rate for Payer: AlohaCare Medicare $82.50
Rate for Payer: Cash Price $107.25
Rate for Payer: Cash Price $107.25
Rate for Payer: Devoted Health Medicare $90.75
Rate for Payer: Hawaii Medical Service Association ABD $19.90
Rate for Payer: Hawaii Medical Service Association Commercial $18.01
Rate for Payer: Hawaii Medical Service Association Medicare $82.50
Rate for Payer: Hawaii Medical Service Association Non-ABD $20.90
Rate for Payer: Hawaii Western Management Group Commercial $14.41
Rate for Payer: Health Management Network Commercial $140.25
Rate for Payer: Humana Medicare $82.50
Rate for Payer: Kaiser Permanente Commercial $148.50
Rate for Payer: Kaiser Permanente Medicaid $84.15
Rate for Payer: Kaiser Permanente Medicare $82.50
Rate for Payer: MDX Hawaii PPO $160.05
Rate for Payer: Ohana Health Plan Medicaid $82.50
Rate for Payer: Ohana Health Plan Medicare $82.50
Rate for Payer: UnitedHealthcare Medicaid $19.90
Rate for Payer: UnitedHealthcare Medicare $82.50
Rate for Payer: University Health Alliance Commercial $37.22
Service Code HCPCS 86778
Hospital Charge Code 8404554
Hospital Revenue Code 302
Min. Negotiated Rate $140.25
Max. Negotiated Rate $160.05
Rate for Payer: Cash Price $107.25
Rate for Payer: Health Management Network Commercial $140.25
Rate for Payer: Kaiser Permanente Commercial $148.50
Rate for Payer: MDX Hawaii PPO $160.05
Service Code HCPCS 86406
Hospital Charge Code 8118064
Hospital Revenue Code 302
Min. Negotiated Rate $107.10
Max. Negotiated Rate $122.22
Rate for Payer: Cash Price $81.90
Rate for Payer: Health Management Network Commercial $107.10
Rate for Payer: Kaiser Permanente Commercial $113.40
Rate for Payer: MDX Hawaii PPO $122.22
Service Code HCPCS 86406
Hospital Charge Code 8118064
Hospital Revenue Code 302
Min. Negotiated Rate $10.64
Max. Negotiated Rate $122.22
Rate for Payer: AlohaCare Medicaid $63.00
Rate for Payer: AlohaCare Medicare $63.00
Rate for Payer: Cash Price $81.90
Rate for Payer: Cash Price $81.90
Rate for Payer: Devoted Health Medicare $69.30
Rate for Payer: Hawaii Medical Service Association ABD $14.58
Rate for Payer: Hawaii Medical Service Association Commercial $13.30
Rate for Payer: Hawaii Medical Service Association Medicare $63.00
Rate for Payer: Hawaii Medical Service Association Non-ABD $15.31
Rate for Payer: Hawaii Western Management Group Commercial $10.64
Rate for Payer: Health Management Network Commercial $107.10
Rate for Payer: Humana Medicare $63.00
Rate for Payer: Kaiser Permanente Commercial $113.40
Rate for Payer: Kaiser Permanente Medicaid $64.26
Rate for Payer: Kaiser Permanente Medicare $63.00
Rate for Payer: MDX Hawaii PPO $122.22
Rate for Payer: Ohana Health Plan Medicaid $63.00
Rate for Payer: Ohana Health Plan Medicare $63.00
Rate for Payer: UnitedHealthcare Medicaid $14.58
Rate for Payer: UnitedHealthcare Medicare $63.00
Rate for Payer: University Health Alliance Commercial $27.51
Service Code HCPCS 86777
Hospital Charge Code 9904297
Hospital Revenue Code 302
Min. Negotiated Rate $14.39
Max. Negotiated Rate $110.58
Rate for Payer: AlohaCare Medicaid $57.00
Rate for Payer: AlohaCare Medicare $57.00
Rate for Payer: Cash Price $74.10
Rate for Payer: Cash Price $74.10
Rate for Payer: Devoted Health Medicare $62.70
Rate for Payer: Hawaii Medical Service Association ABD $19.89
Rate for Payer: Hawaii Medical Service Association Commercial $17.99
Rate for Payer: Hawaii Medical Service Association Medicare $57.00
Rate for Payer: Hawaii Medical Service Association Non-ABD $20.88
Rate for Payer: Hawaii Western Management Group Commercial $14.39
Rate for Payer: Health Management Network Commercial $96.90
Rate for Payer: Humana Medicare $57.00
Rate for Payer: Kaiser Permanente Commercial $102.60
Rate for Payer: Kaiser Permanente Medicaid $58.14
Rate for Payer: Kaiser Permanente Medicare $57.00
Rate for Payer: MDX Hawaii PPO $110.58
Rate for Payer: Ohana Health Plan Medicaid $57.00
Rate for Payer: Ohana Health Plan Medicare $57.00
Rate for Payer: UnitedHealthcare Medicaid $19.89
Rate for Payer: UnitedHealthcare Medicare $57.00
Rate for Payer: University Health Alliance Commercial $37.20
Service Code HCPCS 86777
Hospital Charge Code 9904297
Hospital Revenue Code 302
Min. Negotiated Rate $96.90
Max. Negotiated Rate $110.58
Rate for Payer: Cash Price $74.10
Rate for Payer: Health Management Network Commercial $96.90
Rate for Payer: Kaiser Permanente Commercial $102.60
Rate for Payer: MDX Hawaii PPO $110.58
Service Code HCPCS 86777
Hospital Charge Code 10004696
Hospital Revenue Code 302
Min. Negotiated Rate $14.39
Max. Negotiated Rate $110.58
Rate for Payer: AlohaCare Medicaid $57.00
Rate for Payer: AlohaCare Medicare $57.00
Rate for Payer: Cash Price $74.10
Rate for Payer: Cash Price $74.10
Rate for Payer: Devoted Health Medicare $62.70
Rate for Payer: Hawaii Medical Service Association ABD $19.89
Rate for Payer: Hawaii Medical Service Association Commercial $17.99
Rate for Payer: Hawaii Medical Service Association Medicare $57.00
Rate for Payer: Hawaii Medical Service Association Non-ABD $20.88
Rate for Payer: Hawaii Western Management Group Commercial $14.39
Rate for Payer: Health Management Network Commercial $96.90
Rate for Payer: Humana Medicare $57.00
Rate for Payer: Kaiser Permanente Commercial $102.60
Rate for Payer: Kaiser Permanente Medicaid $58.14
Rate for Payer: Kaiser Permanente Medicare $57.00
Rate for Payer: MDX Hawaii PPO $110.58
Rate for Payer: Ohana Health Plan Medicaid $57.00
Rate for Payer: Ohana Health Plan Medicare $57.00
Rate for Payer: UnitedHealthcare Medicaid $19.89
Rate for Payer: UnitedHealthcare Medicare $57.00
Rate for Payer: University Health Alliance Commercial $37.20
Service Code HCPCS 86777
Hospital Charge Code 10004696
Hospital Revenue Code 302
Min. Negotiated Rate $96.90
Max. Negotiated Rate $110.58
Rate for Payer: Cash Price $74.10
Rate for Payer: Health Management Network Commercial $96.90
Rate for Payer: Kaiser Permanente Commercial $102.60
Rate for Payer: MDX Hawaii PPO $110.58
Service Code HCPCS C1713
Hospital Charge Code 13000863
Hospital Revenue Code 278
Min. Negotiated Rate $731.00
Max. Negotiated Rate $1,418.14
Rate for Payer: AlohaCare Medicaid $731.00
Rate for Payer: AlohaCare Medicare $731.00
Rate for Payer: Cash Price $950.30
Rate for Payer: Devoted Health Medicare $804.10
Rate for Payer: Hawaii Medical Service Association Medicare $731.00
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Humana Medicare $731.00
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: Kaiser Permanente Medicaid $745.62
Rate for Payer: Kaiser Permanente Medicare $731.00
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: Ohana Health Plan Medicaid $731.00
Rate for Payer: Ohana Health Plan Medicare $731.00
Rate for Payer: UnitedHealthcare Medicare $731.00
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000863
Hospital Revenue Code 278
Min. Negotiated Rate $818.72
Max. Negotiated Rate $1,418.14
Rate for Payer: Cash Price $950.30
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000874
Hospital Revenue Code 278
Min. Negotiated Rate $818.72
Max. Negotiated Rate $1,418.14
Rate for Payer: Cash Price $950.30
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000874
Hospital Revenue Code 278
Min. Negotiated Rate $731.00
Max. Negotiated Rate $1,418.14
Rate for Payer: AlohaCare Medicaid $731.00
Rate for Payer: AlohaCare Medicare $731.00
Rate for Payer: Cash Price $950.30
Rate for Payer: Devoted Health Medicare $804.10
Rate for Payer: Hawaii Medical Service Association Medicare $731.00
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Humana Medicare $731.00
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: Kaiser Permanente Medicaid $745.62
Rate for Payer: Kaiser Permanente Medicare $731.00
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: Ohana Health Plan Medicaid $731.00
Rate for Payer: Ohana Health Plan Medicare $731.00
Rate for Payer: UnitedHealthcare Medicare $731.00
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000875
Hospital Revenue Code 278
Min. Negotiated Rate $818.72
Max. Negotiated Rate $1,418.14
Rate for Payer: Cash Price $950.30
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000875
Hospital Revenue Code 278
Min. Negotiated Rate $731.00
Max. Negotiated Rate $1,418.14
Rate for Payer: AlohaCare Medicaid $731.00
Rate for Payer: AlohaCare Medicare $731.00
Rate for Payer: Cash Price $950.30
Rate for Payer: Devoted Health Medicare $804.10
Rate for Payer: Hawaii Medical Service Association Medicare $731.00
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Humana Medicare $731.00
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: Kaiser Permanente Medicaid $745.62
Rate for Payer: Kaiser Permanente Medicare $731.00
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: Ohana Health Plan Medicaid $731.00
Rate for Payer: Ohana Health Plan Medicare $731.00
Rate for Payer: UnitedHealthcare Medicare $731.00
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000880
Hospital Revenue Code 278
Min. Negotiated Rate $1,402.80
Max. Negotiated Rate $2,429.85
Rate for Payer: Cash Price $1,628.25
Rate for Payer: Hawaii Western Management Group Commercial $1,753.50
Rate for Payer: Health Management Network Commercial $2,129.25
Rate for Payer: Kaiser Permanente Commercial $2,254.50
Rate for Payer: MDX Hawaii PPO $2,429.85
Rate for Payer: University Health Alliance Commercial $1,402.80
Service Code HCPCS C1713
Hospital Charge Code 13000880
Hospital Revenue Code 278
Min. Negotiated Rate $1,252.50
Max. Negotiated Rate $2,429.85
Rate for Payer: AlohaCare Medicaid $1,252.50
Rate for Payer: AlohaCare Medicare $1,252.50
Rate for Payer: Cash Price $1,628.25
Rate for Payer: Devoted Health Medicare $1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare $1,252.50
Rate for Payer: Hawaii Western Management Group Commercial $1,753.50
Rate for Payer: Health Management Network Commercial $2,129.25
Rate for Payer: Humana Medicare $1,252.50
Rate for Payer: Kaiser Permanente Commercial $2,254.50
Rate for Payer: Kaiser Permanente Medicaid $1,277.55
Rate for Payer: Kaiser Permanente Medicare $1,252.50
Rate for Payer: MDX Hawaii PPO $2,429.85
Rate for Payer: Ohana Health Plan Medicaid $1,252.50
Rate for Payer: Ohana Health Plan Medicare $1,252.50
Rate for Payer: UnitedHealthcare Medicare $1,252.50
Rate for Payer: University Health Alliance Commercial $1,402.80
Service Code HCPCS C1713
Hospital Charge Code 13000876
Hospital Revenue Code 278
Min. Negotiated Rate $818.72
Max. Negotiated Rate $1,418.14
Rate for Payer: Cash Price $950.30
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000876
Hospital Revenue Code 278
Min. Negotiated Rate $731.00
Max. Negotiated Rate $1,418.14
Rate for Payer: AlohaCare Medicaid $731.00
Rate for Payer: AlohaCare Medicare $731.00
Rate for Payer: Cash Price $950.30
Rate for Payer: Devoted Health Medicare $804.10
Rate for Payer: Hawaii Medical Service Association Medicare $731.00
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Humana Medicare $731.00
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: Kaiser Permanente Medicaid $745.62
Rate for Payer: Kaiser Permanente Medicare $731.00
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: Ohana Health Plan Medicaid $731.00
Rate for Payer: Ohana Health Plan Medicare $731.00
Rate for Payer: UnitedHealthcare Medicare $731.00
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000877
Hospital Revenue Code 278
Min. Negotiated Rate $731.00
Max. Negotiated Rate $1,418.14
Rate for Payer: AlohaCare Medicaid $731.00
Rate for Payer: AlohaCare Medicare $731.00
Rate for Payer: Cash Price $950.30
Rate for Payer: Devoted Health Medicare $804.10
Rate for Payer: Hawaii Medical Service Association Medicare $731.00
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Humana Medicare $731.00
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: Kaiser Permanente Medicaid $745.62
Rate for Payer: Kaiser Permanente Medicare $731.00
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: Ohana Health Plan Medicaid $731.00
Rate for Payer: Ohana Health Plan Medicare $731.00
Rate for Payer: UnitedHealthcare Medicare $731.00
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000877
Hospital Revenue Code 278
Min. Negotiated Rate $818.72
Max. Negotiated Rate $1,418.14
Rate for Payer: Cash Price $950.30
Rate for Payer: Hawaii Western Management Group Commercial $1,023.40
Rate for Payer: Health Management Network Commercial $1,242.70
Rate for Payer: Kaiser Permanente Commercial $1,315.80
Rate for Payer: MDX Hawaii PPO $1,418.14
Rate for Payer: University Health Alliance Commercial $818.72
Service Code HCPCS C1713
Hospital Charge Code 13000882
Hospital Revenue Code 278
Min. Negotiated Rate $1,402.80
Max. Negotiated Rate $2,429.85
Rate for Payer: Cash Price $1,628.25
Rate for Payer: Hawaii Western Management Group Commercial $1,753.50
Rate for Payer: Health Management Network Commercial $2,129.25
Rate for Payer: Kaiser Permanente Commercial $2,254.50
Rate for Payer: MDX Hawaii PPO $2,429.85
Rate for Payer: University Health Alliance Commercial $1,402.80
Service Code HCPCS C1713
Hospital Charge Code 13000882
Hospital Revenue Code 278
Min. Negotiated Rate $1,252.50
Max. Negotiated Rate $2,429.85
Rate for Payer: AlohaCare Medicaid $1,252.50
Rate for Payer: AlohaCare Medicare $1,252.50
Rate for Payer: Cash Price $1,628.25
Rate for Payer: Devoted Health Medicare $1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare $1,252.50
Rate for Payer: Hawaii Western Management Group Commercial $1,753.50
Rate for Payer: Health Management Network Commercial $2,129.25
Rate for Payer: Humana Medicare $1,252.50
Rate for Payer: Kaiser Permanente Commercial $2,254.50
Rate for Payer: Kaiser Permanente Medicaid $1,277.55
Rate for Payer: Kaiser Permanente Medicare $1,252.50
Rate for Payer: MDX Hawaii PPO $2,429.85
Rate for Payer: Ohana Health Plan Medicaid $1,252.50
Rate for Payer: Ohana Health Plan Medicare $1,252.50
Rate for Payer: UnitedHealthcare Medicare $1,252.50
Rate for Payer: University Health Alliance Commercial $1,402.80
Service Code HCPCS C1713
Hospital Charge Code 13000883
Hospital Revenue Code 278
Min. Negotiated Rate $1,402.80
Max. Negotiated Rate $2,429.85
Rate for Payer: Cash Price $1,628.25
Rate for Payer: Hawaii Western Management Group Commercial $1,753.50
Rate for Payer: Health Management Network Commercial $2,129.25
Rate for Payer: Kaiser Permanente Commercial $2,254.50
Rate for Payer: MDX Hawaii PPO $2,429.85
Rate for Payer: University Health Alliance Commercial $1,402.80