|
US Paracentesis - Report
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
661685
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$92.74 |
| Max. Negotiated Rate |
$1,072.70 |
| Rate for Payer: AlohaCare Medicaid |
$105.50
|
| Rate for Payer: AlohaCare Medicare |
$92.74
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Cash Price |
$820.30
|
| Rate for Payer: Devoted Health Medicare |
$102.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$105.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$165.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.74
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$105.50
|
| Rate for Payer: Health Management Network Commercial |
$1,072.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$111.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$111.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$105.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$105.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.74
|
| Rate for Payer: University Health Alliance Commercial |
$140.13
|
|
|
US Pelvic Complete
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
8102137
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$648.55 |
| Max. Negotiated Rate |
$740.11 |
| Rate for Payer: Cash Price |
$495.95
|
| Rate for Payer: Health Management Network Commercial |
$648.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$686.70
|
| Rate for Payer: MDX Hawaii PPO |
$740.11
|
|
|
US Pelvic Complete
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
8102137
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$740.11 |
| Rate for Payer: UnitedHealthcare Medicare |
$381.50
|
| Rate for Payer: AlohaCare Medicaid |
$381.50
|
| Rate for Payer: AlohaCare Medicare |
$381.50
|
| Rate for Payer: Cash Price |
$495.95
|
| Rate for Payer: Cash Price |
$495.95
|
| Rate for Payer: Devoted Health Medicare |
$419.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$381.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$648.55
|
| Rate for Payer: Humana Medicare |
$381.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$686.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$389.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$381.50
|
| Rate for Payer: MDX Hawaii PPO |
$740.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$381.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$381.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: University Health Alliance Commercial |
$231.53
|
|
|
US Pelvic Complete - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76856 26
|
| Hospital Charge Code |
8102139
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$69.99
|
| Rate for Payer: AlohaCare Medicare |
$33.03
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$36.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.03
|
|
|
US Pelvic Ltd
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
8100934
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$643.11 |
| Rate for Payer: AlohaCare Medicaid |
$331.50
|
| Rate for Payer: AlohaCare Medicare |
$331.50
|
| Rate for Payer: Cash Price |
$430.95
|
| Rate for Payer: Cash Price |
$430.95
|
| Rate for Payer: Devoted Health Medicare |
$364.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$331.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$69.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$563.55
|
| Rate for Payer: Humana Medicare |
$331.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$596.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$338.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$331.50
|
| Rate for Payer: MDX Hawaii PPO |
$643.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$331.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$331.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$331.50
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
US Pelvic Ltd
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
8100934
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$643.11 |
| Rate for Payer: Cash Price |
$430.95
|
| Rate for Payer: Health Management Network Commercial |
$563.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$596.70
|
| Rate for Payer: MDX Hawaii PPO |
$643.11
|
|
|
US Pelvic Ltd - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76857 26
|
| Hospital Charge Code |
8100936
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$32.12
|
| Rate for Payer: AlohaCare Medicare |
$24.16
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$26.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$66.85
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.16
|
|
|
US Pelvis Comp w/Transvag if indicated
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
2425368
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$786.67 |
| Rate for Payer: AlohaCare Medicaid |
$405.50
|
| Rate for Payer: AlohaCare Medicare |
$405.50
|
| Rate for Payer: Cash Price |
$527.15
|
| Rate for Payer: Cash Price |
$527.15
|
| Rate for Payer: Devoted Health Medicare |
$446.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$405.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$689.35
|
| Rate for Payer: Humana Medicare |
$405.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$413.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$405.50
|
| Rate for Payer: MDX Hawaii PPO |
$786.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$405.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$405.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$405.50
|
| Rate for Payer: University Health Alliance Commercial |
$231.53
|
|
|
US Pelvis Comp w/Transvag if indicated
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
2425368
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$689.35 |
| Max. Negotiated Rate |
$786.67 |
| Rate for Payer: Cash Price |
$527.15
|
| Rate for Payer: Health Management Network Commercial |
$689.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$729.90
|
| Rate for Payer: MDX Hawaii PPO |
$786.67
|
|
|
US Pelvis Comp w/Transvag if indicated - Report
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76856 26
|
| Hospital Charge Code |
2425370
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: AlohaCare Medicaid |
$69.99
|
| Rate for Payer: AlohaCare Medicare |
$33.03
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Devoted Health Medicare |
$36.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.25
|
| Rate for Payer: Health Management Network Commercial |
$123.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.03
|
|
|
US Pelvis Limited POC
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
10234942
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| 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 |
$44.29
|
| 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 |
$69.53
|
| 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 |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
US Pelvis Limited POC
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
10234942
|
|
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 Pelvis Ltd w/Transvag if indicated
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
2425371
|
|
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 Pelvis Ltd w/Transvag if indicated
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
2425371
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$44.29 |
| 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 |
$44.29
|
| 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 |
$69.53
|
| 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 |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$354.00
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
US Perc Drainage Abscess POC
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
10234953
|
|
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 Perc Drainage Abscess POC
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
10234953
|
|
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 Pyloris
|
Facility
|
OP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8099951
|
|
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 Pyloris
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
8099951
|
|
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 Pyloris - Report
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76705 26
|
| Hospital Charge Code |
8099953
|
|
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 Renal Artery Duplex Complete
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
11401720
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$185.92 |
| Max. Negotiated Rate |
$1,481.19 |
| Rate for Payer: AlohaCare Medicaid |
$763.50
|
| Rate for Payer: AlohaCare Medicare |
$763.50
|
| Rate for Payer: Cash Price |
$992.55
|
| Rate for Payer: Cash Price |
$992.55
|
| Rate for Payer: Devoted Health Medicare |
$839.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$185.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$304.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$763.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$222.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,450.65
|
| Rate for Payer: Health Management Network Commercial |
$1,297.95
|
| Rate for Payer: Humana Medicare |
$763.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,374.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$778.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$763.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,481.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$763.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$763.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$763.50
|
| Rate for Payer: University Health Alliance Commercial |
$855.12
|
|
|
US Renal Artery Duplex Complete
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
HCPCS 93975
|
| Hospital Charge Code |
11401720
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,297.95 |
| Max. Negotiated Rate |
$1,481.19 |
| Rate for Payer: Cash Price |
$992.55
|
| Rate for Payer: Health Management Network Commercial |
$1,297.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,374.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,481.19
|
|
|
US Renal Artery Duplex Complete - Report
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 93975 26
|
| Hospital Charge Code |
11401719
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$53.53 |
| Max. Negotiated Rate |
$644.30 |
| Rate for Payer: AlohaCare Medicaid |
$295.00
|
| Rate for Payer: AlohaCare Medicare |
$53.53
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| 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 |
$644.30
|
| 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 Renal Artery Duplex Limited
|
Facility
|
IP
|
$935.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
8277444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$794.75 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
|
|
US Renal Artery Duplex Limited
|
Facility
|
OP
|
$935.00
|
|
|
Service Code
|
HCPCS 93976
|
| Hospital Charge Code |
8277444
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$906.95 |
| Rate for Payer: AlohaCare Medicaid |
$467.50
|
| Rate for Payer: AlohaCare Medicare |
$467.50
|
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Cash Price |
$607.75
|
| Rate for Payer: Devoted Health Medicare |
$514.25
|
| 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 |
$467.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$125.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$888.25
|
| Rate for Payer: Health Management Network Commercial |
$794.75
|
| Rate for Payer: Humana Medicare |
$467.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$476.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$467.50
|
| Rate for Payer: MDX Hawaii PPO |
$906.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$467.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$467.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$106.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$467.50
|
| Rate for Payer: University Health Alliance Commercial |
$523.60
|
|
|
US Renal Artery Duplex Limited - Report
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 93976 26
|
| Hospital Charge Code |
8277446
|
|
Hospital Revenue Code
|
976
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: AlohaCare Medicaid |
$176.72
|
| Rate for Payer: AlohaCare Medicare |
$37.65
|
| Rate for Payer: Cash Price |
$174.85
|
| Rate for Payer: Cash Price |
$174.85
|
| 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 |
$228.65
|
| 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
|
|
