|
US Abdomen Doppler Complete - Report
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 93975 26
|
| Hospital Charge Code |
9042544
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$376.55 |
| Rate for Payer: AlohaCare Medicaid |
$295.00
|
| Rate for Payer: AlohaCare Medicare |
$53.53
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Cash Price |
$287.95
|
| Rate for Payer: Devoted Health Medicare |
$58.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$264.52
|
| Rate for Payer: Health Management Network Commercial |
$376.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$64.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$295.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$295.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.53
|
|
|
US Abdomen Doppler Limited
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
9042545
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: AlohaCare Medicaid |
$947.50
|
| Rate for Payer: AlohaCare Medicare |
$947.50
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Devoted Health Medicare |
$1,042.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$947.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,800.25
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Humana Medicare |
$947.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$966.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$947.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$947.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$947.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$947.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,061.20
|
|
|
US Abdomen Doppler Limited
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
9042545
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,610.75 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
|
|
US Abdomen Doppler Limited - Report
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 93976 26
|
| Hospital Charge Code |
9042547
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$176.72 |
| Rate for Payer: AlohaCare Medicaid |
$176.72
|
| Rate for Payer: AlohaCare Medicare |
$37.65
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$41.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.97
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.65
|
|
|
US Abdomen Limited POC
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
10248134
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$601.80 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
|
|
US Abdomen Limited POC
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
10248134
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$686.76 |
| Rate for Payer: AlohaCare Medicaid |
$354.00
|
| Rate for Payer: AlohaCare Medicare |
$354.00
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Cash Price |
$460.20
|
| Rate for Payer: Devoted Health Medicare |
$389.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$354.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$601.80
|
| Rate for Payer: Humana Medicare |
$354.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$637.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$361.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$354.00
|
| Rate for Payer: MDX Hawaii PPO |
$686.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$354.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$354.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$200.93
|
|
|
US Abdomen Limited POC
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
10248134
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$57.67 |
| Max. Negotiated Rate |
$434.26 |
| Rate for Payer: AlohaCare Medicaid |
$57.67
|
| Rate for Payer: AlohaCare Medicare |
$94.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$104.04
|
| 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 |
$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 |
$265.97
|
| 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 Non-ABD |
$434.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.50
|
| 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 |
$339.46
|
| 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: Kaiser Permanente Medicare |
$246.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$434.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$209.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$265.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$303.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.46
|
|
|
US Abdomen Limited - Report
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76705 26
|
| Hospital Charge Code |
625611
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: AlohaCare Medicaid |
$57.67
|
| Rate for Payer: AlohaCare Medicare |
$27.93
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Devoted Health Medicare |
$30.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.64
|
| Rate for Payer: Health Management Network Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.93
|
|
|
US Abdomen Vascular Limited
|
Facility
|
OP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
9078907
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: AlohaCare Medicaid |
$947.50
|
| Rate for Payer: AlohaCare Medicare |
$947.50
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Devoted Health Medicare |
$1,042.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$106.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$947.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,800.25
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Humana Medicare |
$947.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$966.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$947.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$947.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$947.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$947.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,061.20
|
|
|
US Abdomen Vascular Limited
|
Facility
|
IP
|
$1,895.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
9078907
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,610.75 |
| Max. Negotiated Rate |
$1,838.15 |
| Rate for Payer: Cash Price |
$1,231.75
|
| Rate for Payer: Health Management Network Commercial |
$1,610.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,705.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,838.15
|
|
|
US Abdomen Vascular Limited - Report
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 93976 26
|
| Hospital Charge Code |
9078909
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$176.72 |
| Rate for Payer: AlohaCare Medicaid |
$176.72
|
| Rate for Payer: AlohaCare Medicare |
$37.65
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Cash Price |
$107.25
|
| Rate for Payer: Devoted Health Medicare |
$41.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$171.97
|
| Rate for Payer: Health Management Network Commercial |
$140.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.65
|
|
|
US Amniocentesis
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS 76946
|
| Hospital Charge Code |
1169707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: AlohaCare Medicaid |
$189.50
|
| Rate for Payer: AlohaCare Medicare |
$189.50
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Devoted Health Medicare |
$208.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$189.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$52.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$360.05
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Humana Medicare |
$189.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$193.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$189.50
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$189.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$189.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$189.50
|
| Rate for Payer: University Health Alliance Commercial |
$113.53
|
|
|
US Amniocentesis
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS 76946
|
| Hospital Charge Code |
1169707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$322.15 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Cash Price |
$246.35
|
| Rate for Payer: Health Management Network Commercial |
$322.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$341.10
|
| Rate for Payer: MDX Hawaii PPO |
$367.63
|
|
|
US Amniocentesis - Report
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 76946 26
|
| Hospital Charge Code |
625671
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$87.87 |
| Rate for Payer: AlohaCare Medicaid |
$21.58
|
| Rate for Payer: AlohaCare Medicare |
$18.82
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Cash Price |
$34.45
|
| Rate for Payer: Devoted Health Medicare |
$20.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.87
|
| Rate for Payer: Health Management Network Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.82
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
8110948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$1,906.05 |
| Rate for Payer: AlohaCare Medicaid |
$982.50
|
| Rate for Payer: AlohaCare Medicare |
$982.50
|
| Rate for Payer: Cash Price |
$1,277.25
|
| Rate for Payer: Cash Price |
$1,277.25
|
| Rate for Payer: Devoted Health Medicare |
$1,080.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$982.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$70.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$1,670.25
|
| Rate for Payer: Humana Medicare |
$982.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,768.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,002.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$982.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,906.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$982.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$982.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$982.50
|
| Rate for Payer: University Health Alliance Commercial |
$258.91
|
|
|
US Aorta Complete
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 76770
|
| Hospital Charge Code |
8110948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,670.25 |
| Max. Negotiated Rate |
$1,906.05 |
| Rate for Payer: Cash Price |
$1,277.25
|
| Rate for Payer: Health Management Network Commercial |
$1,670.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,768.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,906.05
|
|
|
US Aorta Complete - Report
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 76770 26
|
| Hospital Charge Code |
8110949
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: AlohaCare Medicaid |
$71.79
|
| Rate for Payer: AlohaCare Medicare |
$34.70
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Cash Price |
$116.35
|
| Rate for Payer: Devoted Health Medicare |
$38.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.33
|
| Rate for Payer: Health Management Network Commercial |
$152.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$71.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.70
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
1169577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,905.70 |
| Max. Negotiated Rate |
$2,174.74 |
| Rate for Payer: Cash Price |
$1,457.30
|
| Rate for Payer: Health Management Network Commercial |
$1,905.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,017.80
|
| Rate for Payer: MDX Hawaii PPO |
$2,174.74
|
|
|
US Aorta IVC Iliac Duplex Complete
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
HCPCS 93978
|
| Hospital Charge Code |
1169577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$2,174.74 |
| Rate for Payer: AlohaCare Medicaid |
$1,121.00
|
| Rate for Payer: AlohaCare Medicare |
$1,121.00
|
| Rate for Payer: Cash Price |
$1,457.30
|
| Rate for Payer: Cash Price |
$1,457.30
|
| Rate for Payer: Devoted Health Medicare |
$1,233.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$130.61
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,121.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$137.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,129.90
|
| Rate for Payer: Health Management Network Commercial |
$1,905.70
|
| Rate for Payer: Humana Medicare |
$1,121.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,017.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,143.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,121.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,174.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,121.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,121.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$130.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,121.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,255.52
|
|
|
US Aorta IVC Iliac Duplex Complete - Report
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 93978 26
|
| Hospital Charge Code |
625733
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.91 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: AlohaCare Medicaid |
$200.41
|
| Rate for Payer: AlohaCare Medicare |
$36.91
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Cash Price |
$215.80
|
| Rate for Payer: Devoted Health Medicare |
$40.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$155.73
|
| Rate for Payer: Health Management Network Commercial |
$282.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$200.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.91
|
|
|
US Aorta IVC Iliac Duplex Limited
|
Facility
|
IP
|
$1,567.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
1169579
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,331.95 |
| Max. Negotiated Rate |
$1,519.99 |
| Rate for Payer: Cash Price |
$1,018.55
|
| Rate for Payer: Health Management Network Commercial |
$1,331.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,410.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.99
|
|
|
US Aorta IVC Iliac Duplex Limited
|
Facility
|
OP
|
$1,567.00
|
|
|
Service Code
|
HCPCS 93979
|
| Hospital Charge Code |
1169579
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.67 |
| Max. Negotiated Rate |
$1,519.99 |
| Rate for Payer: AlohaCare Medicaid |
$783.50
|
| Rate for Payer: AlohaCare Medicare |
$783.50
|
| Rate for Payer: Cash Price |
$1,018.55
|
| Rate for Payer: Cash Price |
$1,018.55
|
| Rate for Payer: Devoted Health Medicare |
$861.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$86.67
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$783.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$97.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,488.65
|
| Rate for Payer: Health Management Network Commercial |
$1,331.95
|
| Rate for Payer: Humana Medicare |
$783.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,410.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$799.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$783.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,519.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$783.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$783.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$86.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$783.50
|
| Rate for Payer: University Health Alliance Commercial |
$877.52
|
|
|
US Aorta IVC Iliac Duplex Limited - Report
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 93979 26
|
| Hospital Charge Code |
625735
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: AlohaCare Medicaid |
$131.35
|
| Rate for Payer: AlohaCare Medicare |
$22.84
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Devoted Health Medicare |
$25.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$103.66
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$131.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$131.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.84
|
|
|
US Aorta Limited
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
8110950
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
|
|
US Aorta Limited
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
8110950
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$1,455.00 |
| Rate for Payer: AlohaCare Medicaid |
$750.00
|
| Rate for Payer: AlohaCare Medicare |
$750.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Devoted Health Medicare |
$825.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$750.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$1,275.00
|
| Rate for Payer: Humana Medicare |
$750.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,350.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$765.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$750.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,455.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$750.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$750.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$750.00
|
| Rate for Payer: University Health Alliance Commercial |
$202.63
|
|
