Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

US OB < 14 weeks w/ TVS if indicated - Report

Professional

Both

$181.00

Service Code	HCPCS 76801 26
Hospital Charge Code	630923
Hospital Revenue Code	972
Min. Negotiated Rate	$47.42
Max. Negotiated Rate	$153.85
Rate for Payer: AlohaCare Medicaid	$77.25
Rate for Payer: AlohaCare Medicare	$47.42
Rate for Payer: Cash Price	$117.65
Rate for Payer: Cash Price	$117.65
Rate for Payer: Devoted Health Medicare	$52.16
Rate for Payer: Hawaii Medical Service Association Medicare	$47.42
Rate for Payer: Hawaii Western Management Group Commercial	$102.63
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$52.16
Rate for Payer: Kaiser Permanente Medicaid	$52.16
Rate for Payer: Kaiser Permanente Medicare	$52.16
Rate for Payer: Ohana Health Plan Medicaid	$77.25
Rate for Payer: Ohana Health Plan Medicare	$47.42
Rate for Payer: UnitedHealthcare Medicaid	$77.25
Rate for Payer: UnitedHealthcare Medicare	$47.42

US OB Detailed Complete First Gest

Facility

$1,111.00

Service Code	HCPCS 76811
Hospital Charge Code	8112319
Hospital Revenue Code	402
Min. Negotiated Rate	$112.44
Max. Negotiated Rate	$1,077.67
Rate for Payer: AlohaCare Medicaid	$555.50
Rate for Payer: AlohaCare Medicare	$555.50
Rate for Payer: Cash Price	$722.15
Rate for Payer: Cash Price	$722.15
Rate for Payer: Devoted Health Medicare	$611.05
Rate for Payer: Hawaii Medical Service Association ABD	$112.44
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$555.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$131.50
Rate for Payer: Hawaii Western Management Group Commercial	$243.77
Rate for Payer: Health Management Network Commercial	$944.35
Rate for Payer: Humana Medicare	$555.50
Rate for Payer: Kaiser Permanente Commercial	$999.90
Rate for Payer: Kaiser Permanente Medicaid	$566.61
Rate for Payer: Kaiser Permanente Medicare	$555.50
Rate for Payer: MDX Hawaii PPO	$1,077.67
Rate for Payer: Ohana Health Plan Medicaid	$555.50
Rate for Payer: Ohana Health Plan Medicare	$555.50
Rate for Payer: UnitedHealthcare Medicaid	$112.44
Rate for Payer: UnitedHealthcare Medicare	$555.50
Rate for Payer: University Health Alliance Commercial	$436.01

US OB Detailed Complete First Gest

Facility

$1,111.00

Service Code	HCPCS 76811
Hospital Charge Code	8112319
Hospital Revenue Code	402
Min. Negotiated Rate	$944.35
Max. Negotiated Rate	$1,077.67
Rate for Payer: Cash Price	$722.15
Rate for Payer: Health Management Network Commercial	$944.35
Rate for Payer: Kaiser Permanente Commercial	$999.90
Rate for Payer: MDX Hawaii PPO	$1,077.67

US OB Detailed Complete First Gest - Report

Professional

Both

$332.00

Service Code	HCPCS 76811 26
Hospital Charge Code	8112321
Hospital Revenue Code	972
Min. Negotiated Rate	$92.96
Max. Negotiated Rate	$282.20
Rate for Payer: AlohaCare Medicaid	$115.61
Rate for Payer: AlohaCare Medicare	$92.96
Rate for Payer: Cash Price	$215.80
Rate for Payer: Cash Price	$215.80
Rate for Payer: Devoted Health Medicare	$102.26
Rate for Payer: Hawaii Medical Service Association Medicare	$92.96
Rate for Payer: Hawaii Western Management Group Commercial	$243.15
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Kaiser Permanente Commercial	$102.26
Rate for Payer: Kaiser Permanente Medicaid	$102.26
Rate for Payer: Kaiser Permanente Medicare	$102.26
Rate for Payer: Ohana Health Plan Medicaid	$115.61
Rate for Payer: Ohana Health Plan Medicare	$92.96
Rate for Payer: UnitedHealthcare Medicaid	$115.61
Rate for Payer: UnitedHealthcare Medicare	$92.96

US OB Follow Up

Facility

$573.00

Service Code	HCPCS 76816
Hospital Charge Code	1169854
Hospital Revenue Code	402
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$555.81
Rate for Payer: AlohaCare Medicaid	$286.50
Rate for Payer: AlohaCare Medicare	$286.50
Rate for Payer: Cash Price	$372.45
Rate for Payer: Cash Price	$372.45
Rate for Payer: Devoted Health Medicare	$315.15
Rate for Payer: Hawaii Medical Service Association ABD	$36.81
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$286.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.59
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Humana Medicare	$286.50
Rate for Payer: Kaiser Permanente Commercial	$515.70
Rate for Payer: Kaiser Permanente Medicaid	$292.23
Rate for Payer: Kaiser Permanente Medicare	$286.50
Rate for Payer: MDX Hawaii PPO	$555.81
Rate for Payer: Ohana Health Plan Medicaid	$286.50
Rate for Payer: Ohana Health Plan Medicare	$286.50
Rate for Payer: UnitedHealthcare Medicaid	$36.81
Rate for Payer: UnitedHealthcare Medicare	$286.50
Rate for Payer: University Health Alliance Commercial	$203.81

US OB Follow Up

Facility

$573.00

Service Code	HCPCS 76816
Hospital Charge Code	1169854
Hospital Revenue Code	402
Min. Negotiated Rate	$487.05
Max. Negotiated Rate	$555.81
Rate for Payer: Cash Price	$372.45
Rate for Payer: Health Management Network Commercial	$487.05
Rate for Payer: Kaiser Permanente Commercial	$515.70
Rate for Payer: MDX Hawaii PPO	$555.81

US OB Follow up POC

Facility

$710.00

Service Code	HCPCS 76816
Hospital Charge Code	10248135
Hospital Revenue Code	402
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$688.70
Rate for Payer: AlohaCare Medicaid	$355.00
Rate for Payer: AlohaCare Medicare	$355.00
Rate for Payer: Cash Price	$461.50
Rate for Payer: Cash Price	$461.50
Rate for Payer: Devoted Health Medicare	$390.50
Rate for Payer: Hawaii Medical Service Association ABD	$36.81
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$355.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.59
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$603.50
Rate for Payer: Humana Medicare	$355.00
Rate for Payer: Kaiser Permanente Commercial	$639.00
Rate for Payer: Kaiser Permanente Medicaid	$362.10
Rate for Payer: Kaiser Permanente Medicare	$355.00
Rate for Payer: MDX Hawaii PPO	$688.70
Rate for Payer: Ohana Health Plan Medicaid	$355.00
Rate for Payer: Ohana Health Plan Medicare	$355.00
Rate for Payer: UnitedHealthcare Medicaid	$36.81
Rate for Payer: UnitedHealthcare Medicare	$355.00
Rate for Payer: University Health Alliance Commercial	$203.81

US OB Follow up POC

Facility

$710.00

Service Code	HCPCS 76816
Hospital Charge Code	10248135
Hospital Revenue Code	402
Min. Negotiated Rate	$603.50
Max. Negotiated Rate	$688.70
Rate for Payer: Cash Price	$461.50
Rate for Payer: Health Management Network Commercial	$603.50
Rate for Payer: Kaiser Permanente Commercial	$639.00
Rate for Payer: MDX Hawaii PPO	$688.70

US OB Follow Up - Report

Professional

Both

$155.00

Service Code	HCPCS 76816 26
Hospital Charge Code	630912
Hospital Revenue Code	972
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$131.75
Rate for Payer: AlohaCare Medicaid	$72.85
Rate for Payer: AlohaCare Medicare	$41.79
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$45.97
Rate for Payer: Hawaii Medical Service Association Medicare	$41.79
Rate for Payer: Hawaii Western Management Group Commercial	$80.34
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$45.97
Rate for Payer: Kaiser Permanente Medicaid	$45.97
Rate for Payer: Kaiser Permanente Medicare	$45.97
Rate for Payer: Ohana Health Plan Medicaid	$72.85
Rate for Payer: Ohana Health Plan Medicare	$41.79
Rate for Payer: UnitedHealthcare Medicaid	$72.85
Rate for Payer: UnitedHealthcare Medicare	$41.79

US OB Greater Than 14 Weeks

Facility

$761.00

Service Code	HCPCS 76805
Hospital Charge Code	1169850
Hospital Revenue Code	402
Min. Negotiated Rate	$646.85
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$494.65
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: MDX Hawaii PPO	$738.17

US OB Greater Than 14 Weeks

Facility

$761.00

Service Code	HCPCS 76805
Hospital Charge Code	1169850
Hospital Revenue Code	402
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$738.17
Rate for Payer: AlohaCare Medicaid	$380.50
Rate for Payer: AlohaCare Medicare	$380.50
Rate for Payer: Cash Price	$494.65
Rate for Payer: Cash Price	$494.65
Rate for Payer: Devoted Health Medicare	$418.55
Rate for Payer: Hawaii Medical Service Association ABD	$61.23
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$380.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$75.32
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Humana Medicare	$380.50
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: Kaiser Permanente Medicare	$380.50
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: Ohana Health Plan Medicaid	$380.50
Rate for Payer: Ohana Health Plan Medicare	$380.50
Rate for Payer: UnitedHealthcare Medicaid	$61.23
Rate for Payer: UnitedHealthcare Medicare	$380.50
Rate for Payer: University Health Alliance Commercial	$287.45

US OB Greater Than 14 Weeks - Report

Professional

Both

$181.00

Service Code	HCPCS 76805 26
Hospital Charge Code	630920
Hospital Revenue Code	972
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$153.85
Rate for Payer: AlohaCare Medicaid	$89.75
Rate for Payer: AlohaCare Medicare	$48.18
Rate for Payer: Cash Price	$117.65
Rate for Payer: Cash Price	$117.65
Rate for Payer: Devoted Health Medicare	$53.00
Rate for Payer: Hawaii Medical Service Association Medicare	$48.18
Rate for Payer: Hawaii Western Management Group Commercial	$146.63
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$53.00
Rate for Payer: Kaiser Permanente Medicaid	$53.00
Rate for Payer: Kaiser Permanente Medicare	$53.00
Rate for Payer: Ohana Health Plan Medicaid	$89.75
Rate for Payer: Ohana Health Plan Medicare	$48.18
Rate for Payer: UnitedHealthcare Medicaid	$89.75
Rate for Payer: UnitedHealthcare Medicare	$48.18

US OB Limited

Facility

$708.00

Service Code	HCPCS 76815
Hospital Charge Code	1169856
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 OB Limited

Facility

$708.00

Service Code	HCPCS 76815
Hospital Charge Code	1169856
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	$183.63

US OB Limited POC

Facility

$708.00

Service Code	HCPCS 76815
Hospital Charge Code	10234941
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	$183.63

US OB Limited POC

Facility

$708.00

Service Code	HCPCS 76815
Hospital Charge Code	10234941
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 OB Limited - Report

Professional

Both

$145.00

Service Code	HCPCS 76815 26
Hospital Charge Code	630908
Hospital Revenue Code	972
Min. Negotiated Rate	$31.31
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$53.36
Rate for Payer: AlohaCare Medicare	$31.31
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$34.44
Rate for Payer: Hawaii Medical Service Association Medicare	$31.31
Rate for Payer: Hawaii Western Management Group Commercial	$98.47
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$34.44
Rate for Payer: Kaiser Permanente Medicaid	$34.44
Rate for Payer: Kaiser Permanente Medicare	$34.44
Rate for Payer: Ohana Health Plan Medicaid	$53.36
Rate for Payer: Ohana Health Plan Medicare	$31.31
Rate for Payer: UnitedHealthcare Medicaid	$53.36
Rate for Payer: UnitedHealthcare Medicare	$31.31

US OB Transvaginal

Facility

$758.00

Service Code	HCPCS 76817
Hospital Charge Code	1169861
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 OB Transvaginal

Facility

$758.00

Service Code	HCPCS 76817
Hospital Charge Code	1169861
Hospital Revenue Code	402
Min. Negotiated Rate	$46.06
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	$46.06
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.86
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
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	$46.06
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$193.75

US OB Transvaginal - Report

Professional

Both

$135.00

Service Code	HCPCS 76817 26
Hospital Charge Code	630904
Hospital Revenue Code	972
Min. Negotiated Rate	$36.17
Max. Negotiated Rate	$114.75
Rate for Payer: AlohaCare Medicaid	$61.09
Rate for Payer: AlohaCare Medicare	$36.17
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Devoted Health Medicare	$39.79
Rate for Payer: Hawaii Medical Service Association Medicare	$36.17
Rate for Payer: Hawaii Western Management Group Commercial	$97.48
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$39.79
Rate for Payer: Kaiser Permanente Medicaid	$39.79
Rate for Payer: Kaiser Permanente Medicare	$39.79
Rate for Payer: Ohana Health Plan Medicaid	$61.09
Rate for Payer: Ohana Health Plan Medicare	$36.17
Rate for Payer: UnitedHealthcare Medicaid	$61.09
Rate for Payer: UnitedHealthcare Medicare	$36.17

US OB Tranvaginal POC

Facility

$758.00

Service Code	HCPCS 76817
Hospital Charge Code	10239193
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 OB Tranvaginal POC

Facility

$758.00

Service Code	HCPCS 76817
Hospital Charge Code	10239193
Hospital Revenue Code	402
Min. Negotiated Rate	$46.06
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	$46.06
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.86
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
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	$46.06
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$193.75

US Paracentesis

Facility

$1,780.00

Service Code	HCPCS 49083
Hospital Charge Code	1169838
Hospital Revenue Code	361
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$890.00
Rate for Payer: AlohaCare Medicare	$890.00
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Devoted Health Medicare	$979.00
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$890.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,513.00
Rate for Payer: Humana Medicare	$890.00
Rate for Payer: Kaiser Permanente Commercial	$1,602.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$890.00
Rate for Payer: MDX Hawaii PPO	$1,726.60
Rate for Payer: Ohana Health Plan Medicaid	$890.00
Rate for Payer: Ohana Health Plan Medicare	$890.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$890.00
Rate for Payer: University Health Alliance Commercial	$1,297.44

US Paracentesis

Facility

$1,780.00

Service Code	HCPCS 49083
Hospital Charge Code	1169838
Hospital Revenue Code	361
Min. Negotiated Rate	$1,513.00
Max. Negotiated Rate	$1,726.60
Rate for Payer: Cash Price	$1,157.00
Rate for Payer: Health Management Network Commercial	$1,513.00
Rate for Payer: Kaiser Permanente Commercial	$1,602.00
Rate for Payer: MDX Hawaii PPO	$1,726.60

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	$177.92
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	$102.01
Rate for Payer: Kaiser Permanente Medicaid	$102.01
Rate for Payer: Kaiser Permanente Medicare	$102.01
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

Know your out-of-pocket cost for care.

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