|
US Fine Needle Aspiration w/ Guidance
|
Facility
|
OP
|
$2,665.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
2425347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.18 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,332.50
|
| Rate for Payer: AlohaCare Medicare |
$1,332.50
|
| Rate for Payer: Cash Price |
$1,732.25
|
| Rate for Payer: Cash Price |
$1,732.25
|
| Rate for Payer: Cash Price |
$1,732.25
|
| Rate for Payer: Devoted Health Medicare |
$1,465.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$904.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,332.50
|
| Rate for Payer: Health Management Network Commercial |
$2,265.25
|
| Rate for Payer: Humana Medicare |
$1,332.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,398.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,332.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,585.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,332.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,332.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,332.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,492.40
|
|
|
US Fine Needle Aspiration w/ Guidance
|
Facility
|
IP
|
$2,665.00
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
2425347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,265.25 |
| Max. Negotiated Rate |
$2,585.05 |
| Rate for Payer: Cash Price |
$1,732.25
|
| Rate for Payer: Health Management Network Commercial |
$2,265.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,398.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,585.05
|
|
|
US Guidance Needle Placement POC
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
10239191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$542.23 |
| Rate for Payer: Cash Price |
$363.35
|
| Rate for Payer: Health Management Network Commercial |
$475.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.10
|
| Rate for Payer: MDX Hawaii PPO |
$542.23
|
|
|
US Guidance Needle Placement POC
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
10239191
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$542.23 |
| Rate for Payer: AlohaCare Medicaid |
$279.50
|
| Rate for Payer: AlohaCare Medicare |
$279.50
|
| Rate for Payer: Cash Price |
$363.35
|
| Rate for Payer: Cash Price |
$363.35
|
| Rate for Payer: Devoted Health Medicare |
$307.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$104.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$531.05
|
| Rate for Payer: Health Management Network Commercial |
$475.15
|
| Rate for Payer: Humana Medicare |
$279.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$285.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.50
|
| Rate for Payer: MDX Hawaii PPO |
$542.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.50
|
| Rate for Payer: University Health Alliance Commercial |
$361.51
|
|
|
US Guided Abdominal Mass Biopsy
|
Facility
|
IP
|
$2,635.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
8211776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,239.75 |
| Max. Negotiated Rate |
$2,555.95 |
| Rate for Payer: Cash Price |
$1,712.75
|
| Rate for Payer: Health Management Network Commercial |
$2,239.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,371.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,555.95
|
|
|
US Guided Abdominal Mass Biopsy
|
Facility
|
OP
|
$2,635.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
8211776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$2,555.95 |
| Rate for Payer: AlohaCare Medicaid |
$1,317.50
|
| Rate for Payer: AlohaCare Medicare |
$1,317.50
|
| Rate for Payer: Cash Price |
$1,712.75
|
| Rate for Payer: Cash Price |
$1,712.75
|
| Rate for Payer: Cash Price |
$1,712.75
|
| Rate for Payer: Devoted Health Medicare |
$1,449.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,109.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,317.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,503.25
|
| Rate for Payer: Health Management Network Commercial |
$2,239.75
|
| Rate for Payer: Humana Medicare |
$1,317.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,371.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,343.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,317.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,555.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,317.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,317.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,317.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,475.60
|
|
|
US Guided Abdominal Mass Biopsy - Report
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
8211778
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$69.80 |
| Max. Negotiated Rate |
$1,954.15 |
| Rate for Payer: AlohaCare Medicaid |
$80.65
|
| Rate for Payer: AlohaCare Medicare |
$69.80
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Devoted Health Medicare |
$76.78
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$80.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$127.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$80.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$158.86
|
| Rate for Payer: Health Management Network Commercial |
$1,954.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.80
|
| Rate for Payer: University Health Alliance Commercial |
$108.08
|
|
|
US Guided Drain Placement
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
8211779
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,048.90 |
| Max. Negotiated Rate |
$1,196.98 |
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,110.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.98
|
|
|
US Guided Drain Placement
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
8211779
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$1,196.98 |
| Rate for Payer: AlohaCare Medicaid |
$617.00
|
| Rate for Payer: AlohaCare Medicare |
$617.00
|
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Cash Price |
$802.10
|
| Rate for Payer: Devoted Health Medicare |
$678.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$103.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$617.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$112.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,172.30
|
| Rate for Payer: Health Management Network Commercial |
$1,048.90
|
| Rate for Payer: Humana Medicare |
$617.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,110.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$629.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$617.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,196.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$617.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$617.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$103.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$617.00
|
| Rate for Payer: University Health Alliance Commercial |
$317.64
|
|
|
US Guided Drain Placement - Report
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 75989 26
|
| Hospital Charge Code |
8211781
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$202.69 |
| Rate for Payer: AlohaCare Medicaid |
$72.05
|
| Rate for Payer: AlohaCare Medicare |
$55.10
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$60.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$202.69
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$66.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$72.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$72.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.10
|
|
|
US Guided Needle Placement
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
8110639
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$475.15 |
| Max. Negotiated Rate |
$542.23 |
| Rate for Payer: Cash Price |
$363.35
|
| Rate for Payer: Health Management Network Commercial |
$475.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.10
|
| Rate for Payer: MDX Hawaii PPO |
$542.23
|
|
|
US Guided Needle Placement
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
8110639
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$542.23 |
| Rate for Payer: AlohaCare Medicaid |
$279.50
|
| Rate for Payer: AlohaCare Medicare |
$279.50
|
| Rate for Payer: Cash Price |
$363.35
|
| Rate for Payer: Cash Price |
$363.35
|
| Rate for Payer: Devoted Health Medicare |
$307.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$73.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$104.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$531.05
|
| Rate for Payer: Health Management Network Commercial |
$475.15
|
| Rate for Payer: Humana Medicare |
$279.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$503.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$285.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.50
|
| Rate for Payer: MDX Hawaii PPO |
$542.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.50
|
| Rate for Payer: University Health Alliance Commercial |
$361.51
|
|
|
US Guided Needle Placement - Report
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 76942 26
|
| Hospital Charge Code |
8110641
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: AlohaCare Medicaid |
$37.47
|
| Rate for Payer: AlohaCare Medicare |
$32.16
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Cash Price |
$79.95
|
| Rate for Payer: Devoted Health Medicare |
$35.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.35
|
| Rate for Payer: Health Management Network Commercial |
$104.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.16
|
|
|
US Guided Vascular Access
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
2425350
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$437.75 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
|
|
US Guided Vascular Access
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
2425350
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: AlohaCare Medicaid |
$257.50
|
| Rate for Payer: AlohaCare Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Devoted Health Medicare |
$283.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$489.25
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Humana Medicare |
$257.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$262.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.50
|
| Rate for Payer: University Health Alliance Commercial |
$69.04
|
|
|
US Guide Vascular Access POC
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
10239190
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: AlohaCare Medicaid |
$257.50
|
| Rate for Payer: AlohaCare Medicare |
$257.50
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Devoted Health Medicare |
$283.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$257.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$489.25
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Humana Medicare |
$257.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$262.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$257.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$257.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$257.50
|
| Rate for Payer: University Health Alliance Commercial |
$69.04
|
|
|
US Guide Vascular Access POC
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
10239190
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$437.75 |
| Max. Negotiated Rate |
$499.55 |
| Rate for Payer: Cash Price |
$334.75
|
| Rate for Payer: Health Management Network Commercial |
$437.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$463.50
|
| Rate for Payer: MDX Hawaii PPO |
$499.55
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
1169729
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$592.67 |
| Rate for Payer: AlohaCare Medicaid |
$305.50
|
| Rate for Payer: AlohaCare Medicare |
$305.50
|
| Rate for Payer: Cash Price |
$397.15
|
| Rate for Payer: Cash Price |
$397.15
|
| Rate for Payer: Devoted Health Medicare |
$336.05
|
| 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 |
$305.50
|
| 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 |
$519.35
|
| Rate for Payer: Humana Medicare |
$305.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$549.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$311.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$305.50
|
| Rate for Payer: MDX Hawaii PPO |
$592.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$305.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$305.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$305.50
|
| Rate for Payer: University Health Alliance Commercial |
$211.12
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
HCPCS 76536
|
| Hospital Charge Code |
1169729
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$519.35 |
| Max. Negotiated Rate |
$592.67 |
| Rate for Payer: Cash Price |
$397.15
|
| Rate for Payer: Health Management Network Commercial |
$519.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$549.90
|
| Rate for Payer: MDX Hawaii PPO |
$592.67
|
|
|
US Head/Neck Soft Tissue - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76536 26
|
| Hospital Charge Code |
631152
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$73.82
|
| Rate for Payer: AlohaCare Medicare |
$26.93
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$29.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.29
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.93
|
|
|
US Hips Infant Dynamic
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
1169731
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
US Hips Infant Dynamic
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
1169731
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$379.00
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$416.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$111.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$379.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$88.91
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$379.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$379.00
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$379.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$379.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$379.00
|
| Rate for Payer: University Health Alliance Commercial |
$192.77
|
|
|
US Hips Infant Dynamic - Report
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 76885 26
|
| Hospital Charge Code |
631146
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: AlohaCare Medicaid |
$90.49
|
| Rate for Payer: AlohaCare Medicare |
$34.70
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cash Price |
$78.65
|
| 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 |
$107.07
|
| Rate for Payer: Health Management Network Commercial |
$102.85
|
| 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 |
$90.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.70
|
|
|
US Hysterosonogram
|
Facility
|
OP
|
$968.00
|
|
|
Service Code
|
HCPCS 76831
|
| Hospital Charge Code |
1169735
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$938.96 |
| Rate for Payer: AlohaCare Medicaid |
$484.00
|
| Rate for Payer: AlohaCare Medicare |
$484.00
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Devoted Health Medicare |
$532.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$484.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$243.77
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Humana Medicare |
$484.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$493.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$484.00
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$484.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$484.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$484.00
|
| Rate for Payer: University Health Alliance Commercial |
$231.34
|
|
|
US Hysterosonogram
|
Facility
|
IP
|
$968.00
|
|
|
Service Code
|
HCPCS 76831
|
| Hospital Charge Code |
1169735
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$822.80 |
| Max. Negotiated Rate |
$938.96 |
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Health Management Network Commercial |
$822.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$871.20
|
| Rate for Payer: MDX Hawaii PPO |
$938.96
|
|
