|
US Breast Device Plcmnt w/US Guide Right
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
2425320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,340.45 |
| Max. Negotiated Rate |
$1,529.69 |
| Rate for Payer: Cash Price |
$1,025.05
|
| Rate for Payer: Health Management Network Commercial |
$1,340.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,419.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,529.69
|
|
|
US Breast Device Plcmnt w/US Guide Right
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
2425320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$788.50
|
| Rate for Payer: AlohaCare Medicare |
$788.50
|
| Rate for Payer: Cash Price |
$1,025.05
|
| Rate for Payer: Cash Price |
$1,025.05
|
| Rate for Payer: Cash Price |
$1,025.05
|
| Rate for Payer: Devoted Health Medicare |
$867.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$904.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$788.50
|
| Rate for Payer: Health Management Network Commercial |
$1,340.45
|
| Rate for Payer: Humana Medicare |
$788.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,419.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$788.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,529.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$788.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$788.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$788.50
|
| Rate for Payer: University Health Alliance Commercial |
$883.12
|
|
|
US Breast Device Plcmnt w/US Guide Right - Report
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
2425322
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$838.10 |
| Rate for Payer: AlohaCare Medicaid |
$82.71
|
| Rate for Payer: AlohaCare Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Cash Price |
$640.90
|
| Rate for Payer: Devoted Health Medicare |
$77.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.71
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$131.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$534.56
|
| Rate for Payer: Health Management Network Commercial |
$838.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.70
|
| Rate for Payer: University Health Alliance Commercial |
$89.84
|
|
|
US Breast Limited Bilat
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 76642 50
|
| Hospital Charge Code |
8111067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: AlohaCare Medicaid |
$437.00
|
| Rate for Payer: AlohaCare Medicare |
$437.00
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Devoted Health Medicare |
$480.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$437.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$830.30
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Humana Medicare |
$437.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$445.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$437.00
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$437.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$437.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$437.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.63
|
|
|
US Breast Limited Bilat
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 76642 50
|
| Hospital Charge Code |
8111067
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
|
|
US Breast Limited Bilat - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 76642 26
|
| Hospital Charge Code |
8111069
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: AlohaCare Medicaid |
$55.91
|
| Rate for Payer: AlohaCare Medicare |
$31.93
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Devoted Health Medicare |
$35.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.67
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.93
|
|
|
US Breast Limited Left
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4645480
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: AlohaCare Medicaid |
$437.00
|
| Rate for Payer: AlohaCare Medicare |
$437.00
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Devoted Health Medicare |
$480.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$437.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Humana Medicare |
$437.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$445.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$437.00
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$437.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$437.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$437.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.63
|
|
|
US Breast Limited Left
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4645480
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
|
|
US Breast Limited Left - Report
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 76642 26
|
| Hospital Charge Code |
4645482
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$99.67 |
| Rate for Payer: AlohaCare Medicaid |
$55.91
|
| Rate for Payer: AlohaCare Medicare |
$31.93
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$35.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.67
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.93
|
|
|
US Breast Limited Right
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4645483
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: AlohaCare Medicaid |
$437.00
|
| Rate for Payer: AlohaCare Medicare |
$437.00
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Devoted Health Medicare |
$480.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$34.94
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$437.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Humana Medicare |
$437.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$445.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$437.00
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$437.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$437.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$437.00
|
| Rate for Payer: University Health Alliance Commercial |
$182.63
|
|
|
US Breast Limited Right
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4645483
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.91 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: AlohaCare Medicaid |
$55.91
|
| Rate for Payer: AlohaCare Medicare |
$90.99
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Devoted Health Medicare |
$100.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.67
|
| Rate for Payer: Health Management Network Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$109.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$109.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.99
|
|
|
US Breast Limited Right
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 76642
|
| Hospital Charge Code |
4645483
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$742.90 |
| Max. Negotiated Rate |
$847.78 |
| Rate for Payer: Cash Price |
$568.10
|
| Rate for Payer: Health Management Network Commercial |
$742.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$786.60
|
| Rate for Payer: MDX Hawaii PPO |
$847.78
|
|
|
US Breast Limited Right - Report
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 76642 26
|
| Hospital Charge Code |
4645485
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$99.67 |
| Rate for Payer: AlohaCare Medicaid |
$55.91
|
| Rate for Payer: AlohaCare Medicare |
$31.93
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$35.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.67
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.93
|
|
|
US BREAST MARKER CLIP (US)
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
8890534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.00 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.00
|
| Rate for Payer: MDX Hawaii PPO |
$329.80
|
|
|
US BREAST MARKER CLIP (US)
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
8890534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$329.80 |
| Rate for Payer: AlohaCare Medicaid |
$170.00
|
| Rate for Payer: AlohaCare Medicare |
$170.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Devoted Health Medicare |
$187.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.00
|
| Rate for Payer: Health Management Network Commercial |
$289.00
|
| Rate for Payer: Humana Medicare |
$170.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.00
|
| Rate for Payer: MDX Hawaii PPO |
$329.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.00
|
| Rate for Payer: University Health Alliance Commercial |
$247.83
|
|
|
US Carotid Duplex Bilateral
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
1169631
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$1,271.67 |
| Rate for Payer: AlohaCare Medicaid |
$655.50
|
| Rate for Payer: AlohaCare Medicare |
$655.50
|
| Rate for Payer: Cash Price |
$852.15
|
| Rate for Payer: Cash Price |
$852.15
|
| Rate for Payer: Devoted Health Medicare |
$721.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$142.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$655.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$169.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,245.45
|
| Rate for Payer: Health Management Network Commercial |
$1,114.35
|
| Rate for Payer: Humana Medicare |
$655.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,179.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$668.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$655.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,271.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$655.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$655.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$655.50
|
| Rate for Payer: University Health Alliance Commercial |
$734.16
|
|
|
US Carotid Duplex Bilateral
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
1169631
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,114.35 |
| Max. Negotiated Rate |
$1,271.67 |
| Rate for Payer: Cash Price |
$852.15
|
| Rate for Payer: Health Management Network Commercial |
$1,114.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,179.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,271.67
|
|
|
US Carotid Duplex Bilateral - Report
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 93880 26
|
| Hospital Charge Code |
629663
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$212.08 |
| Rate for Payer: AlohaCare Medicaid |
$212.08
|
| Rate for Payer: AlohaCare Medicare |
$37.66
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$41.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$165.42
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$212.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$212.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.66
|
|
|
US Carotid Duplex Unilat/Limited
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 93882 LT
|
| Hospital Charge Code |
7822552
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$89.14 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: AlohaCare Medicaid |
$400.00
|
| Rate for Payer: AlohaCare Medicare |
$400.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Devoted Health Medicare |
$440.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$400.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$106.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$760.00
|
| Rate for Payer: Health Management Network Commercial |
$680.00
|
| Rate for Payer: Humana Medicare |
$400.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$720.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$408.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$400.00
|
| Rate for Payer: MDX Hawaii PPO |
$776.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$400.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$400.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$400.00
|
| Rate for Payer: University Health Alliance Commercial |
$448.00
|
|
|
US Carotid Duplex Unilat/Limited
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 93882 LT
|
| Hospital Charge Code |
7822552
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$680.00 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Health Management Network Commercial |
$680.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$720.00
|
| Rate for Payer: MDX Hawaii PPO |
$776.00
|
|
|
US Chest
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
1169635
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$661.54 |
| Rate for Payer: AlohaCare Medicaid |
$341.00
|
| Rate for Payer: AlohaCare Medicare |
$341.00
|
| Rate for Payer: Cash Price |
$443.30
|
| Rate for Payer: Cash Price |
$443.30
|
| Rate for Payer: Devoted Health Medicare |
$375.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$341.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$579.70
|
| Rate for Payer: Humana Medicare |
$341.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$613.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$347.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$341.00
|
| Rate for Payer: MDX Hawaii PPO |
$661.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$341.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$341.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$341.00
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
US Chest
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
1169635
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$579.70 |
| Max. Negotiated Rate |
$661.54 |
| Rate for Payer: Cash Price |
$443.30
|
| Rate for Payer: Health Management Network Commercial |
$579.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$613.80
|
| Rate for Payer: MDX Hawaii PPO |
$661.54
|
|
|
US Chest Bedside POC
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
10625629
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$808.01 |
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Health Management Network Commercial |
$708.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.70
|
| Rate for Payer: MDX Hawaii PPO |
$808.01
|
|
|
US Chest Bedside POC
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
10625629
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$808.01 |
| Rate for Payer: AlohaCare Medicaid |
$416.50
|
| Rate for Payer: AlohaCare Medicare |
$416.50
|
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Cash Price |
$541.45
|
| Rate for Payer: Devoted Health Medicare |
$458.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$42.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$416.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$46.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$708.05
|
| Rate for Payer: Humana Medicare |
$416.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$749.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$424.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$416.50
|
| Rate for Payer: MDX Hawaii PPO |
$808.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$416.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$416.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$416.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
US Chest POC
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
12220300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$623.05 |
| Max. Negotiated Rate |
$711.01 |
| Rate for Payer: Cash Price |
$476.45
|
| Rate for Payer: Health Management Network Commercial |
$623.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$659.70
|
| Rate for Payer: MDX Hawaii PPO |
$711.01
|
|
