|
US Chest POC
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
12220300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$711.01 |
| Rate for Payer: AlohaCare Medicaid |
$366.50
|
| Rate for Payer: AlohaCare Medicare |
$366.50
|
| Rate for Payer: Cash Price |
$476.45
|
| Rate for Payer: Cash Price |
$476.45
|
| Rate for Payer: Devoted Health Medicare |
$403.15
|
| 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 |
$366.50
|
| 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 |
$623.05
|
| Rate for Payer: Humana Medicare |
$366.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$659.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$373.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$366.50
|
| Rate for Payer: MDX Hawaii PPO |
$711.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$366.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$366.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$366.50
|
| Rate for Payer: University Health Alliance Commercial |
$171.44
|
|
|
US Chest - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76604 26
|
| Hospital Charge Code |
629715
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$37.02
|
| Rate for Payer: AlohaCare Medicare |
$28.12
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$30.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$33.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.12
|
|
|
US Doppler Middle Cerebral Artery
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 76821
|
| Hospital Charge Code |
8211666
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$492.15 |
| Max. Negotiated Rate |
$561.63 |
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.10
|
| Rate for Payer: MDX Hawaii PPO |
$561.63
|
|
|
US Doppler Middle Cerebral Artery
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 76821
|
| Hospital Charge Code |
8211666
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.43 |
| Max. Negotiated Rate |
$561.63 |
| Rate for Payer: AlohaCare Medicaid |
$289.50
|
| Rate for Payer: AlohaCare Medicare |
$289.50
|
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Cash Price |
$376.35
|
| Rate for Payer: Devoted Health Medicare |
$318.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$289.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$60.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$492.15
|
| Rate for Payer: Humana Medicare |
$289.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$295.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$289.50
|
| Rate for Payer: MDX Hawaii PPO |
$561.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$289.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$289.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$289.50
|
| Rate for Payer: University Health Alliance Commercial |
$202.02
|
|
|
US Doppler Middle Cerebral Artery - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76821 26
|
| Hospital Charge Code |
8211668
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$34.31 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$58.84
|
| Rate for Payer: AlohaCare Medicare |
$34.31
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$37.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$110.75
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$41.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.31
|
|
|
US Doppler Umbilical Artery
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
8111073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.43 |
| Max. Negotiated Rate |
$657.66 |
| Rate for Payer: AlohaCare Medicaid |
$339.00
|
| Rate for Payer: AlohaCare Medicare |
$339.00
|
| Rate for Payer: Cash Price |
$440.70
|
| Rate for Payer: Cash Price |
$440.70
|
| Rate for Payer: Devoted Health Medicare |
$372.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$51.43
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$339.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$57.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$576.30
|
| Rate for Payer: Humana Medicare |
$339.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$345.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$339.00
|
| Rate for Payer: MDX Hawaii PPO |
$657.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$339.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$339.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$339.00
|
| Rate for Payer: University Health Alliance Commercial |
$133.24
|
|
|
US Doppler Umbilical Artery
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
HCPCS 76820
|
| Hospital Charge Code |
8111073
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$576.30 |
| Max. Negotiated Rate |
$657.66 |
| Rate for Payer: Cash Price |
$440.70
|
| Rate for Payer: Health Management Network Commercial |
$576.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$610.20
|
| Rate for Payer: MDX Hawaii PPO |
$657.66
|
|
|
US Doppler Umbilical Artery - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76820 26
|
| Hospital Charge Code |
8111075
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$29.03
|
| Rate for Payer: AlohaCare Medicare |
$24.73
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$27.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$99.77
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.73
|
|
|
US Drain Per/Retr Fld w/Cath Perc
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
1169657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$360.50
|
| Rate for Payer: AlohaCare Medicare |
$360.50
|
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Devoted Health Medicare |
$396.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$256.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$360.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$684.95
|
| Rate for Payer: Health Management Network Commercial |
$612.85
|
| Rate for Payer: Humana Medicare |
$360.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$648.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$367.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$360.50
|
| Rate for Payer: MDX Hawaii PPO |
$699.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$360.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$360.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$360.50
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
US Drain Per/Retr Fld w/Cath Perc
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
1169657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$612.85 |
| Max. Negotiated Rate |
$699.37 |
| Rate for Payer: Cash Price |
$468.65
|
| Rate for Payer: Health Management Network Commercial |
$612.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$648.90
|
| Rate for Payer: MDX Hawaii PPO |
$699.37
|
|
|
US Echo 2D Complete
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
8111076
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,232.50 |
| Max. Negotiated Rate |
$1,406.50 |
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
|
|
US Echo 2D Complete
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 93307
|
| Hospital Charge Code |
8111076
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$1,406.50 |
| Rate for Payer: AlohaCare Medicaid |
$725.00
|
| Rate for Payer: AlohaCare Medicare |
$725.00
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Cash Price |
$942.50
|
| Rate for Payer: Devoted Health Medicare |
$797.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$127.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$725.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,377.50
|
| Rate for Payer: Health Management Network Commercial |
$1,232.50
|
| Rate for Payer: Humana Medicare |
$725.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,305.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$739.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,406.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$127.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.00
|
| Rate for Payer: University Health Alliance Commercial |
$812.00
|
|
|
US Echo 2D Comp w/ Color Flow Doppler
|
Facility
|
IP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
8207945
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,584.00 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,736.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
|
|
US Echo 2D Comp w/ Color Flow Doppler
|
Facility
|
OP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
8207945
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$132.88 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,520.00
|
| Rate for Payer: AlohaCare Medicare |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Devoted Health Medicare |
$1,672.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,520.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$191.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,888.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Humana Medicare |
$1,520.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,736.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,550.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,520.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,520.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,520.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,520.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,702.40
|
|
|
US Echo 2D Comp w/ Color Flow Doppler EO
|
Facility
|
OP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
8265208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$132.88 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,520.00
|
| Rate for Payer: AlohaCare Medicare |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Devoted Health Medicare |
$1,672.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$132.88
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,520.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$191.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,888.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Humana Medicare |
$1,520.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,736.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,550.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,520.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,520.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,520.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$132.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,520.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,702.40
|
|
|
US Echo 2D Comp w/ Color Flow Doppler EO
|
Facility
|
IP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93306
|
| Hospital Charge Code |
8265208
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,584.00 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,736.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
|
|
US Echo 2D Limited
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8106646
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$64.51 |
| Max. Negotiated Rate |
$1,206.68 |
| Rate for Payer: AlohaCare Medicaid |
$622.00
|
| Rate for Payer: AlohaCare Medicare |
$622.00
|
| Rate for Payer: Cash Price |
$808.60
|
| Rate for Payer: Cash Price |
$808.60
|
| Rate for Payer: Devoted Health Medicare |
$684.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,181.80
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Humana Medicare |
$622.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,119.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$634.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,206.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.00
|
| Rate for Payer: University Health Alliance Commercial |
$696.64
|
|
|
US Echo 2D Limited
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8106646
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,057.40 |
| Max. Negotiated Rate |
$1,206.68 |
| Rate for Payer: Cash Price |
$808.60
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,119.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,206.68
|
|
|
US Echo 2D Limited EO
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8265211
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$64.51 |
| Max. Negotiated Rate |
$1,206.68 |
| Rate for Payer: AlohaCare Medicaid |
$622.00
|
| Rate for Payer: AlohaCare Medicare |
$622.00
|
| Rate for Payer: Cash Price |
$808.60
|
| Rate for Payer: Cash Price |
$808.60
|
| Rate for Payer: Devoted Health Medicare |
$684.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$64.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$67.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,181.80
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Humana Medicare |
$622.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,119.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$634.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,206.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.00
|
| Rate for Payer: University Health Alliance Commercial |
$696.64
|
|
|
US Echo 2D Limited EO
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
HCPCS 93308
|
| Hospital Charge Code |
8265211
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,057.40 |
| Max. Negotiated Rate |
$1,206.68 |
| Rate for Payer: Cash Price |
$808.60
|
| Rate for Payer: Health Management Network Commercial |
$1,057.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,119.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,206.68
|
|
|
US Echocardiogram Complete - Report
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 76930 26
|
| Hospital Charge Code |
8111087
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$104.86 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.86
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
|
|
US Echo TEE
|
Facility
|
IP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
8211773
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,584.00 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,736.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
|
|
US Echo TEE
|
Facility
|
OP
|
$3,040.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
8211773
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$126.66 |
| Max. Negotiated Rate |
$2,948.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,520.00
|
| Rate for Payer: AlohaCare Medicare |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Devoted Health Medicare |
$1,672.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$126.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,520.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$132.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,888.00
|
| Rate for Payer: Health Management Network Commercial |
$2,584.00
|
| Rate for Payer: Humana Medicare |
$1,520.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,736.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,550.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,520.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,948.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,520.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,520.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$126.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,520.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,702.40
|
|
|
US Encephalogram
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
1169679
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$461.55 |
| Max. Negotiated Rate |
$526.71 |
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Health Management Network Commercial |
$461.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$488.70
|
| Rate for Payer: MDX Hawaii PPO |
$526.71
|
|
|
US Encephalogram
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
1169679
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$526.71 |
| Rate for Payer: AlohaCare Medicaid |
$271.50
|
| Rate for Payer: AlohaCare Medicare |
$271.50
|
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Cash Price |
$352.95
|
| Rate for Payer: Devoted Health Medicare |
$298.65
|
| 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 |
$271.50
|
| 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 |
$461.55
|
| Rate for Payer: Humana Medicare |
$271.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$488.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$271.50
|
| Rate for Payer: MDX Hawaii PPO |
$526.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$271.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$271.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$271.50
|
| Rate for Payer: University Health Alliance Commercial |
$185.93
|
|
