|
Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular ne
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
424769379
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$69.04 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$25.20
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$55.20
|
| Rate for Payer: Devoted Health Medicare |
$25.20
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$25.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.20
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.20
|
| Rate for Payer: University Health Alliance Commercial |
$69.04
|
|
|
Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular ne
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
424769379
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
424769369
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$351.90 |
| Max. Negotiated Rate |
$401.58 |
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
| Rate for Payer: MDX Hawaii PPO |
$401.58
|
|
|
Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 76936
|
| Hospital Charge Code |
424769369
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$672.22 |
| Rate for Payer: AlohaCare Medicaid |
$196.00
|
| Rate for Payer: AlohaCare Medicaid |
$207.00
|
| Rate for Payer: AlohaCare Medicare |
$173.88
|
| Rate for Payer: AlohaCare Medicare |
$164.64
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$380.88
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$360.64
|
| Rate for Payer: Devoted Health Medicare |
$164.64
|
| Rate for Payer: Devoted Health Medicare |
$173.88
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$207.51
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$207.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$318.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$164.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$173.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$255.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$255.08
|
| Rate for Payer: Health Management Network Commercial |
$351.90
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Humana Medicare |
$164.64
|
| Rate for Payer: Humana Medicare |
$173.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$372.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$211.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.64
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
| Rate for Payer: MDX Hawaii PPO |
$401.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$164.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$173.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$164.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$173.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$207.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$173.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$164.64
|
| Rate for Payer: University Health Alliance Commercial |
$672.22
|
| Rate for Payer: University Health Alliance Commercial |
$672.22
|
|
|
Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation)
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
424768859
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$192.77 |
| Rate for Payer: AlohaCare Medicaid |
$79.50
|
| Rate for Payer: AlohaCare Medicaid |
$75.00
|
| Rate for Payer: AlohaCare Medicare |
$66.78
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$146.28
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$138.00
|
| Rate for Payer: Devoted Health Medicare |
$63.00
|
| Rate for Payer: Devoted Health Medicare |
$66.78
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$66.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Humana Medicare |
$66.78
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$66.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$66.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$66.78
|
| Rate for Payer: University Health Alliance Commercial |
$192.77
|
| Rate for Payer: University Health Alliance Commercial |
$192.77
|
|
|
Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation)
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 76885
|
| Hospital Charge Code |
424768859
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Health Management Network Commercial |
$135.15
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.10
|
| Rate for Payer: MDX Hawaii PPO |
$145.50
|
| Rate for Payer: MDX Hawaii PPO |
$154.23
|
|
|
Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation)
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
424768869
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: AlohaCare Medicaid |
$64.50
|
| Rate for Payer: AlohaCare Medicaid |
$67.50
|
| Rate for Payer: AlohaCare Medicare |
$56.70
|
| Rate for Payer: AlohaCare Medicare |
$54.18
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$124.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$118.68
|
| Rate for Payer: Devoted Health Medicare |
$54.18
|
| Rate for Payer: Devoted Health Medicare |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$128.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.81
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Humana Medicare |
$54.18
|
| Rate for Payer: Humana Medicare |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.18
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.18
|
| Rate for Payer: University Health Alliance Commercial |
$183.30
|
| Rate for Payer: University Health Alliance Commercial |
$183.30
|
|
|
Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation)
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 76886
|
| Hospital Charge Code |
424768869
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$130.95 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Health Management Network Commercial |
$114.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
| Rate for Payer: MDX Hawaii PPO |
$130.95
|
|
|
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
424768569
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$231.53 |
| Rate for Payer: AlohaCare Medicaid |
$69.00
|
| Rate for Payer: AlohaCare Medicaid |
$73.00
|
| Rate for Payer: AlohaCare Medicare |
$61.32
|
| Rate for Payer: AlohaCare Medicare |
$57.96
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$134.32
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$126.96
|
| Rate for Payer: Devoted Health Medicare |
$57.96
|
| Rate for Payer: Devoted Health Medicare |
$61.32
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$61.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Humana Medicare |
$57.96
|
| Rate for Payer: Humana Medicare |
$61.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$74.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$61.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.96
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$61.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$61.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$61.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.96
|
| Rate for Payer: University Health Alliance Commercial |
$231.53
|
| Rate for Payer: University Health Alliance Commercial |
$231.53
|
|
|
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
424768569
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$124.10 |
| Max. Negotiated Rate |
$141.62 |
| Rate for Payer: Cash Price |
$94.90
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Health Management Network Commercial |
$117.30
|
| Rate for Payer: Health Management Network Commercial |
$124.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$124.20
|
| Rate for Payer: MDX Hawaii PPO |
$133.86
|
| Rate for Payer: MDX Hawaii PPO |
$141.62
|
|
|
Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
424768579
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$40.74 |
| Max. Negotiated Rate |
$161.45 |
| Rate for Payer: AlohaCare Medicaid |
$48.50
|
| Rate for Payer: AlohaCare Medicaid |
$51.50
|
| Rate for Payer: AlohaCare Medicare |
$40.74
|
| Rate for Payer: AlohaCare Medicare |
$43.26
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$89.24
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$94.76
|
| Rate for Payer: Devoted Health Medicare |
$43.26
|
| Rate for Payer: Devoted Health Medicare |
$40.74
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$44.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Humana Medicare |
$40.74
|
| Rate for Payer: Humana Medicare |
$43.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.26
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.74
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
| Rate for Payer: University Health Alliance Commercial |
$161.45
|
|
|
Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles)
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
424768579
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
424768059
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$61.23 |
| Max. Negotiated Rate |
$287.45 |
| Rate for Payer: AlohaCare Medicaid |
$102.00
|
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicaid |
$108.50
|
| Rate for Payer: AlohaCare Medicare |
$86.10
|
| Rate for Payer: AlohaCare Medicare |
$91.14
|
| Rate for Payer: AlohaCare Medicare |
$85.68
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$188.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$187.68
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$199.64
|
| Rate for Payer: Devoted Health Medicare |
$91.14
|
| Rate for Payer: Devoted Health Medicare |
$86.10
|
| Rate for Payer: Devoted Health Medicare |
$85.68
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$61.23
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$61.23
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$61.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Humana Medicare |
$86.10
|
| Rate for Payer: Humana Medicare |
$85.68
|
| Rate for Payer: Humana Medicare |
$91.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.14
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.68
|
| Rate for Payer: University Health Alliance Commercial |
$287.45
|
| Rate for Payer: University Health Alliance Commercial |
$287.45
|
| Rate for Payer: University Health Alliance Commercial |
$287.45
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 76805
|
| Hospital Charge Code |
424768059
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$197.88 |
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Health Management Network Commercial |
$173.40
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: MDX Hawaii PPO |
$197.88
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
424768019
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$265.83 |
| Rate for Payer: AlohaCare Medicaid |
$108.50
|
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$91.14
|
| Rate for Payer: AlohaCare Medicare |
$86.10
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$199.64
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$188.60
|
| Rate for Payer: Devoted Health Medicare |
$86.10
|
| Rate for Payer: Devoted Health Medicare |
$91.14
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$55.49
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$55.49
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Humana Medicare |
$91.14
|
| Rate for Payer: Humana Medicare |
$86.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.10
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.49
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.14
|
| Rate for Payer: University Health Alliance Commercial |
$265.83
|
| Rate for Payer: University Health Alliance Commercial |
$265.83
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 76801
|
| Hospital Charge Code |
424768019
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Cash Price |
$141.05
|
| Rate for Payer: Health Management Network Commercial |
$184.45
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.30
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: MDX Hawaii PPO |
$210.49
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
424768119
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$436.01 |
| Rate for Payer: AlohaCare Medicaid |
$198.00
|
| Rate for Payer: AlohaCare Medicaid |
$210.00
|
| Rate for Payer: AlohaCare Medicare |
$176.40
|
| Rate for Payer: AlohaCare Medicare |
$166.32
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$386.40
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$364.32
|
| Rate for Payer: Devoted Health Medicare |
$166.32
|
| Rate for Payer: Devoted Health Medicare |
$176.40
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$112.44
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$112.44
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$352.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$166.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$176.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$281.87
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Humana Medicare |
$166.32
|
| Rate for Payer: Humana Medicare |
$176.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$378.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$201.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$166.32
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
| Rate for Payer: MDX Hawaii PPO |
$407.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$176.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$166.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$176.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$112.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$176.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$166.32
|
| Rate for Payer: University Health Alliance Commercial |
$436.01
|
| Rate for Payer: University Health Alliance Commercial |
$436.01
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 76811
|
| Hospital Charge Code |
424768119
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$407.40 |
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Health Management Network Commercial |
$336.60
|
| Rate for Payer: Health Management Network Commercial |
$357.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$378.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.40
|
| Rate for Payer: MDX Hawaii PPO |
$384.12
|
| Rate for Payer: MDX Hawaii PPO |
$407.40
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ s
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
424768169
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$203.81 |
| Rate for Payer: AlohaCare Medicaid |
$94.00
|
| Rate for Payer: AlohaCare Medicare |
$78.96
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$172.96
|
| Rate for Payer: Devoted Health Medicare |
$78.96
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$36.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Humana Medicare |
$78.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$95.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.96
|
| Rate for Payer: MDX Hawaii PPO |
$182.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.96
|
| Rate for Payer: University Health Alliance Commercial |
$203.81
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ s
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
424768169
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$159.80 |
| Max. Negotiated Rate |
$182.36 |
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Health Management Network Commercial |
$159.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$169.20
|
| Rate for Payer: MDX Hawaii PPO |
$182.36
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ sy
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
424768169
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$203.81 |
| Rate for Payer: AlohaCare Medicaid |
$89.00
|
| Rate for Payer: AlohaCare Medicare |
$74.76
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$163.76
|
| Rate for Payer: Devoted Health Medicare |
$74.76
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$36.81
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Humana Medicare |
$74.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.76
|
| Rate for Payer: MDX Hawaii PPO |
$172.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.76
|
| Rate for Payer: University Health Alliance Commercial |
$203.81
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ sy
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 76816
|
| Hospital Charge Code |
424768169
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$151.30 |
| Max. Negotiated Rate |
$172.66 |
| Rate for Payer: Cash Price |
$115.70
|
| Rate for Payer: Health Management Network Commercial |
$151.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.20
|
| Rate for Payer: MDX Hawaii PPO |
$172.66
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
424768159
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS 76815
|
| Hospital Charge Code |
424768159
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$183.63 |
| Rate for Payer: AlohaCare Medicaid |
$67.00
|
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$58.80
|
| Rate for Payer: AlohaCare Medicare |
$56.28
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$128.80
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$123.28
|
| Rate for Payer: Devoted Health Medicare |
$56.28
|
| Rate for Payer: Devoted Health Medicare |
$58.80
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$46.98
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$56.28
|
| Rate for Payer: Humana Medicare |
$58.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.28
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.28
|
| Rate for Payer: University Health Alliance Commercial |
$183.63
|
| Rate for Payer: University Health Alliance Commercial |
$183.63
|
|
|
Ultrasound, pregnant uterus, real time with image documentation, transvaginal
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 76817
|
| Hospital Charge Code |
424768179
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$193.75 |
| Rate for Payer: AlohaCare Medicaid |
$78.50
|
| Rate for Payer: AlohaCare Medicaid |
$82.00
|
| Rate for Payer: AlohaCare Medicare |
$68.88
|
| Rate for Payer: AlohaCare Medicare |
$65.94
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$150.88
|
| Rate for Payer: Deseret Mutual Benefit Administrators Commercial |
$144.44
|
| Rate for Payer: Devoted Health Medicare |
$65.94
|
| Rate for Payer: Devoted Health Medicare |
$68.88
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$46.06
|
| Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD |
$46.06
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$154.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$139.40
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Humana Medicare |
$65.94
|
| Rate for Payer: Humana Medicare |
$68.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.94
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
| Rate for Payer: MDX Hawaii PPO |
$159.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.94
|
| Rate for Payer: University Health Alliance Commercial |
$193.75
|
| Rate for Payer: University Health Alliance Commercial |
$193.75
|
|
